Promoting Hope, Preventing Suicide

Research and advice on preventing teen and adult suicide

Revising the Bible of Psychiatry

New “psychiatry bible” proposes suicide risk scales

Affectionately referred to as "the bible" of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has had its fair share of critics. Ideally, the DSM is supposed to bring research to practice, using research to inform diagnoses and treatment, but there's no doubt that there are cultural and political influences involved. As the book infamously characterized homosexuality as a psychological disorder, it's not surprising that some take the DSM with a grain of salt.

Just the same, the revision of the DSM, set to be published in 2013, is garnering a lot of attention in both the popular and professional press.

In the realm of suicide prevention, perhaps the most relevant development is proposed assessment tools for suicide risk. Significant risk factors were drawn from follow-up research with suicide attempt survivors as well as psychological autopsies, interviews with those close to individuals who died by suicide to collect information about individuals' history and experiences prior to suicide.

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Here are the seven risk categories for assessment of adults:

  • Any history of a suicide attempt
  • Long-standing tendency to lose temper or become aggressive with little provocation
  • Living alone, chronic severe pain, or recent (within 3 months) significant loss
  • Recent psychiatric admission/discharge or first diagnosis of major depressive disorder, bipolar disorder, or schizophrenia
  • Recent increase in alcohol abuse or worsening of depressive symptoms
  • Current (within last week) preoccupation with, or plans for suicide
  • Current psychomotor agitation, marked anxiety, or prominent feelings of hopelessness

The more risk factors an individual is experiencing, the greater the concern. No risk factors are weighted more heavily than others; research hasn't indicated that such weighting is appropriate at this time.

What's most interesting to me, clinically and as a public health professional, is the explicit connection between alcohol abuse and suicide risk, which seems to have promising implications for treatment and prevention of alcohol abuse as well as suicidality. Another population-based development is that adolescents would complete their tailored assessment on paper or on a computer, as in-person interviews may not lead to honest answers about suicidality.

What do you think? Comment here, but also feel free to comment on the site www.DSM5.org.

Copyright 2010 Elana Premack Sandler, All Rights Reserved

Elana Premack Sandler, M.S.W., M.P.H., is a public health social worker specializing in violence and injury prevention and adolescent health promotion.

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