Does Repeated Suicide Assessment Give Salience to Suicidal Behavior?


Insulin shock therapy is given in Lapinlahti H...

Image via Wikipedia

Anecdotally, I avoid situations in which I am assessed for suicidality.  It’s intrusive, distressing, and the assessment isn’t used to provide relief from the distress.  For me, it’s a well known risk:harm without any benefit.

“Generally speaking, there is no history of providing psychiatric treatment in the emergency room setting,” says Elizabeth Wharff, director of the Emergency Psychiatry Service at Children’s Hospital Boston. “Since the late 1990s, we have seen a significant increase in the number of cases where an adolescent comes to our emergency room with suicidality and needs inpatient care, but there are no available psychiatric beds anywhere in the area.”

Given that the highest known demographic risk for suicide is that of previous suicide attempt, a couple of studies seem to lead to the notion that the current standard of practice of repeated and frequent assessment of suicidality without treatment to reduce the underlying distressors may actually be contributing to the development of suicidal behavior.

In the first study, demographics of suicide risk after the first hospitalization for a mental illness was explored.

Patients with any major psychiatric disorder are at significant risk for suicide after their first hospital visit, according to new research.
~snip~
Dr. Caine noted that although rates of suicide were less than what other researchers have estimated in the past, they were still quite substantial.

“I think this study really teaches us that all those prior results were in the right direction, but we’re now seeing much more clearly what the proper magnitude is, and what the burden of suicide is.”

“You can also clearly see that the suicide risk continues to climb over years. Certainly there’s a steep climb in the first year after hospitalization, but it continues to climb. So, this isn’t something you think about just the first day or week or month. This is something you think about for years,” he concluded.

It would be reasonable to think that hospitalized patients would have been frequently assessed for suicidality and behavior without receiving any treatment to reduce distressors other than masking symptoms with psychotropic medications.  The overall hospital experience is so antitherapeutic and noxious that overwhelmingly, patients avoid rehospitalizations. But they may leave with heightened acclimation to suicidality by way of the concept discussed in the following study.

The second study deals with understanding mortality salience:

Why did the approval ratings of President George W. Bush— who was perceived as indecisive before September 11, 2001—soar over 90 percent after the terrorist attacks? Because Americans were acutely aware of their own deaths. That is one lesson from the psychological literature on “mortality salience” reviewed in a new article called “The Politics of Mortal Terror.”
~snip~
The fear people felt after 9/11 was real, but it also made them ripe for psychological manipulation, experts say. “We all know that fear tactics have been used by politicians for years to sway votes,” says Cohen. Now psychological research offers insight into the chillingly named “terror management.”

The authors cite studies showing that awareness of mortality tends to make people feel more positive toward heroic, charismatic figures and more punitive toward wrongdoers.
~snip~
Awareness of danger and death can bias even peaceful people toward war or aggression. Iranian students in a control condition preferred the statement of a person preaching understanding and the value of human life over a jihadist call to suicide bombing. But primed to think about death, they grew more positive toward the bomber. Some even said that they might consider becoming a martyr.

As time goes by and the memory of danger and death grows fainter, however, “morality salience” tends to polarize people politically, leading them to cling to their own beliefs and demonize others who hold opposing beliefs—seeing in them the cause of their own endangerment.

Isn’t that interesting! If thinking about mortality and death can induce salience, that would seem to be generalizable to suicidality outside of martyrdom.

In Joiner’s Interpersonal Theory of Suicide, he speaks to the idea that people get acclimated to the idea of suicide.  Frequent assessments of suicidality delve into all of the mechanics of committing suicide:  does the person have a plan, if so, describe it in detail, how will they access the supplies and resources necessary to carry out the plan, where will they do it, will they leave a note, do they have reasons for not doing it, etc.  Even when people deny any and all of these aspects, bringing them up over and over again (let’s call it externally applied rumination) promotes acclimation to the idea of suicide behavior, if not also reinforcing the suicidality (perceived burdensomness and thwarted belongingness). In other words, the assessments serve as mental rehearsing or practice without any treatment whatsoever outside of direct observation (not a treatment), incarceration/involuntary hospitalization (doesn’t treat anything, and increases distress), and removal of the stated intended means (TSA and box cutters, leading to shoe bombers, then underwear, then turban bombs – a moving target, NOT a treatment for suicidality).

Advertisements

One thought on “Does Repeated Suicide Assessment Give Salience to Suicidal Behavior?

  1. I see the assessments and reactions by care providers as reinforcing the overreaction to suicidal ideation. One step to not letting yourself be owned by the thoughts is to stop giving them weight and validation.
    I’m not saying its not serious and should be ignored or dismissed. I do think as individuals who struggle we shouldnt be so afraid of the thoughts in our head. A big part of the distress I see from those admitting to ideation is distress at the thoughts – instead of focusing on the causes, the current life events feeding the thoughts. Its like freaking out about a cough instead of treating the underlying pneumonia.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s