Suicide is defined as the deliberate taking of one’s own life. Although the causes of suicide are often difficult to determine, national suicide rates have been rising. In the United States, suicide is arguably the ninth leading cause of death (U.S. Public Health Service, 1999). Identifying patient suicide risk is an area of concern for all caregivers (doctors, physicians, psychologists, mental health professionals, counselors, therapists, treatment staff, etc.). Suicide among patients is not as infrequent an occurrence as many caregivers think.
Most physicians and mental health professionals agree that all patients do not have to be screened for suicide risk. Yet, a growing consensus of review boards, licensing agencies, litigators, juries and insurance providers contend it is the physician’s and mental health provider’s responsibility to assess seriously depressed and emotionally disturbed patients’ suicide risk. In other words, it is the caregiver’s responsibility to incorporate adequate suicide risk screening when treating depressed and emotionally disturbed individuals.
Many physicians and mental health professionals experience a patient’s suicide at some point in their careers. A patient’s suicide can lead to debilitating personal and professional problems for involved caregivers. Setting emotions aside, suicide-related malpractice lawsuits are a reality in today’s society. Suicide-related literature emphasizes the importance of screening at-risk patients to prevent their suicide (Blumenthal, 1998; APA, 2000; Zametkin, Alter & Yemini, 2001). Screening, assessment or completing a suicide evaluation is important because signs or symptoms of suicidality are easy to overlook.
A significant number of patients that committed suicide saw their doctor (physician) or healthcare provider a few days or weeks prior to committing suicide (Pirkis & Burgess, 1998; Luoma, Martin & Pearson, 2002; Soreff, 2011). Most importantly, suicide screening can help prevent suicide, but secondarily such screening can help deter suicide-related legal and professional penalties.
Determining suicide risk may involve a comprehensive evaluation. Comprehensive psychiatric or suicide evaluations can take up to 4 or 5 hours to complete and they are expensive. An alternative would involve support staff (clerical staff) giving a 30-minute self-administered test. Support or clerical staff would computer-score and print the test report in 2 ½ minutes from inputting the test answers. The test report could then be given to the doctor or mental health professional for their review. The test described herein is the Suicide Evaluation (SE). The remainder of this webpage focuses upon screening at-risk patients, or more specifically, presenting and explaining the Suicide Evaluation (SE).
Suicide Evaluation (SE)
The Suicide Evaluation (SE) is a 142-item self-report suicide screening test that takes an average of 25 to 30 minutes to complete. It identifies, screens or filters out people that are at risk of suicide. Within 2 ½ minutes of entering the patient’s answers into a computer, the Suicide Evaluation (SE) is scored and its report printed on the user’s office printer. To review a Suicide Evaluation report, click on the Example SE Report link. Within minutes, the physician, mental health professional or caregiver now has an objective evidence-based opinion regarding their patient’s suicide risk. Then, contingent upon the physician or caregiver’s education, training, patient interaction and Suicide Evaluation (SE) test results, the physician or caregiver decides how to proceed.
When no one symptom by itself is a good suicide predictor, accurate prediction is greatly enhanced when several separate symptoms or predictors are combined. And to a large extent that is what the Suicide Evaluation does.
The Suicide Evaluation (SE) contains six scales or measures that have been linked in peer-review research to suicide. These six scales are:
1. Truthfulness Scale: measures patient truthfulness while completing the test. This scale identifies denial, guardedness and problem minimization. It is important to know if the patient is truthful (Simon, 2002) and you can rely upon the information provided. Elevated Truthfulness Scale sores also reflect emotional detachment, internalization and withdrawal.
2. Suicide Scale: measures a person’s probability or propensity to commit suicide. When suicidal people do not get help, the probability of suicide increases dramatically (Blumenthal, 1998; Jenkins, 1994; Silverman & Felner, 1995). Suicidal individuals often give many hints, clues, warnings or suicidal insinuations regarding their intentions.
3. Depression Scale: measures self-depreciating emotional states. Melancholy and dysphoria are related disorders. Depression varies between depressed moods to more serious clinical depressions. Depression has been linked to suicide (Brent, Kolko & Birhamer, 1998; Pearson, Conwell & Lyness, 1997).
4. Alcohol Scale: measures the severity of alcohol (beer, wine and liquor) use, and as warranted, abuse. Alcohol has been frequently used or abused prior to suicidal acts (Gossop, 2005; Sher, 2005; Cherpitel, Borges & Wilcox, 2004; Hufford, 2001; May, Van Winkle, Williams, McFeeley, DeBruyn & Serna, 2002). Some therapists suggest it’s like striving for mental numbness or a non-think state.
5. Drugs Scale: measures illicit drug use, and as warranted, the severity of abuse. Drugs refer to marijuana, crack, cocaine, ecstasy, amphetamines, barbiturates, heroin, etc. The ‘numbness of mind’ metaphor may also apply to drug abuse, yet there is growing discussion of an ‘altered state of mind’ (Tart, 1969; McPeake, Kennedy & Gordon, 1991).
6. Stress Coping Abilities Scale: measures a patient’s ability to handle or positively manage perceived stress and pressure. Poor stress management has been linked to suicide (Amir, Kaplan, Efroni, & Kotler, 1999; Thompson, Kaslow, Kingree, Puett, Thompson & Meadows, 1999; de Man, 1988). Extreme Stress Management scores are often indicative of established emotional and mental health problems. Stress management skills are taught. There are stress management classes. However, extreme scores are usually indicative of established emotional or mental health problems.
These Suicide Evaluation (SE) scales combine to form a meaningful suicide profile. The Truthfulness Scale assesses the accuracy of the patient-provided information. The Suicide Scale is the hub, or focal point, around which the other SE scales revolve. Co-occurring problems and disorders such as depression, alcohol, drug or stress coping abilities can exacerbate a patient’s suicidality.
The Suicide Evaluation (SE) integrates a variety of relevant factors into a suicide profile. These factors include, but aren’t limited to, multiple predictors like a person’s thoughts (suicide ideation), verbal clues (“I want to give up and die”), suicidal instruments (razors, pills, guns), moods (emotional isolation, depression), traumatic events (death of a loved one), substance (alcohol and other drugs) abuse, impaired stress handling abilities (overwhelmed), history (prior attempts) and having a suicide plan, etc. It would take a great deal of time to review all of these topics with a patient, record them, score them and come to an objective decision.
This is why the Suicide Evaluation (SE) was developed. To provide physicians, mental health professionals and caregivers with a timely (30 minutes), objective and standardized test that can be used as a screening or assessment instrument at intake, during treatment or counseling and on an as-needed basis. The Suicide Evaluation (SE) often serves as an objective second opinion. When suicidal risk is indicated, the physician, assessor or caregiver brings their experience, education and professional standards to bear to decide how to proceed. Alternatives include administering (or referring for) a comprehensive suicide evaluation; intensive inpatient or outpatient suicide treatment; medication review; consultation with the patient’s family/friends; patient supervision (suicide watch) and other interventions/treatment as warranted. In summary, the Suicide Evaluation (SE) screens or filters out individuals with suicide predisposition that may require further intervention, intensified treatment, direct intervention or referral for specialized suicide treatment services.
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