to inconclusive findings, simply because researchers using the same term may, in fact, have been measuring slightly different psychological, behavioral, or social constructs. Terminology Table 1: Nomenclature Describing Suicidal Behavior Suicide
commonly used by professionals working with concerns about suicide and involved in suicide research is described in Table 1.
Death from injury, poisoning, or suffocation where there is evidence that the injury was self-inflicted and that the deceased intended to kill him- or herself. An action resulting in nonfatal injury, poisoning, or suffocation where there is evidence that the injury was self-inflicted and that the person intended at some level (more than zero) to kill him- or herself. A potentially self-injurious behavior with a nonfatal outcome for which there is evidence that the person intended at some level (nonzero) to kill him- or herself. A suicide attempt may or may not result in injuries. A potentially self-injurious behavior for which there is evidence that the person intended at some level (nonzero) to kill him- or herself. A suicidal act may result in death (completed suicide), injury, or no injury.
Suicide attempt with injuries
Suicide attempt
Suicidal act
Instrumental suicide- related behavior Potentially self-injurious behavior for which there is evidence that (a) the person did not intend to kill him- or herself and (b) the person wished to use the appearance of intending to kill him- or herself to attain some other end (e.g., to seek help, to punish others, to receive attention). Suicide-related behavior Potentially self-injurious behavior for which there is evidence either that (a) the person intended at some level (nonzero) to kill him- or herself, or (b) the person wished to use the appearance of intending to kill him- or herself to attain some other end. Suicide-related behavior comprises suicidal acts and instrumental suicide-related behavior.
Suicide plan
A proposed method of carrying out a course of action that will lead to a potentially self-injurious outcome. Any interpersonal action, verbal or nonverbal, stopping short of a directly self-harmful act that a reasonable person would interpret as communicating or suggesting that a suicidal act or other suicide- related behavior might occur in the near future. Any self-reported thoughts of suicide (i.e., passive ideation) or engaging in suicide-related behavior (i.e., active ideation).
Suicide threat
Suicidal ideation
Non-suicidal self-injury
Self-inflicted injury (e.g., cutting) that is engaged in without suicidal intent.
Note . Definitions for all terms adapted from Glenn et al. (2020) and Klonsky, May, & Saffer (2016). The goal of developing a uniform nomenclature is to
These are thoughts in which death is a desired outcome, but there is no evidence of self-infliction or suicidal intent and can be considered a form of passive suicidal or death ideation. Oftentimes, this is expressed as a wish to die without self-infliction (e.g., “It would be better if I just went to sleep and never woke up,” or “If I were to die tomorrow that would be okay.”). An example would be a 14-year-old boy with sickle cell disease who suffers from multiple pain episodes annually. He struggles to feel connected to his peers and frequently expresses a wish to “get life over with.” Recent meta-analytic research suggests that the 1-year prevalence of passive ideation is 5.8% and lifetime passive ideation is approximately 10.6% (Liu, Bettis, & Burke, 2020). ● Suicidal ideation : These are thoughts in which self- inflicted death is a desired outcome and which may or may not include a plan, but where the thoughts do not involve an explicit attempt. This is often experienced as a “weighing of options” regarding suicide. Although no formal epidemiological studies have been concluded, it is suspected that suicidal ideation is less frequent than morbid ideation (Silverman et al., 2007a). An example is a 16-year-old girl who has suffered from sexual trauma, is failing in school, and has a high level of family conflict. When asked, she is clear that she wants to take her life, but she has not yet formulated a plan of action. ● Suicide plans and preparation : When an individual has begun to contemplate methods that might be used in suicidal behavior, they have moved into a more severe stage of suicidal ideation involving suicide plans. Contemplation of plans is not present in the majority of cases of suicidal ideation, though when present it is often a sign of increased suicide risk (Marie et al., 2020). Plans can vary in the level of detail an individual has considered, but can include
increase the ability of mental health providers, researchers, epidemiologists, and policy makers to better communicate with each other and to better research and intervene with at-risk populations. The knowledge and use of appropriate terminology when dealing with issues related to suicide helps to reduce stigma associated with seeking help. Appropriate use of terminology by the healthcare team and those referring individuals for care promotes appropriate and timely care of at-risk individuals and those affected by suicide, and also and demonstrates respect and sensitivity to the experiences of those affected by suicide. For example, the term “commit suicide” is one that advocacy and other groups challenge because the word “commit” usually connotes engaging in a crime (suicide once was considered a crime). Other inadvertently insensitive healthcare providers will occasionally make similar statements, such as “the patient suicided.” Neither of these terms would be viewed as sensitive, appropriate, or accurate in modern conceptualizations of suicide. Instead, clinicians should use the terms “death by suicide” or “died by suicide” when describing the loss of a patient to suicidal behavior. The term “suicide attempt” should be used in lieu of terms such as “failed suicide” (Frey et al., 2020). ( Note : “Patient” is the standard term in much of the existing literature and used in many treatment settings; “client” is often the preferred term in many behavioral health settings and other settings where behavioral health professionals work with individuals, families, and groups. These terms are used interchangeably throughout the course.) Common terms relevant to suicidal thoughts are as follows: ● Non-suicidal morbid ideation : This is also sometimes referred to as “passive suicidal ideation” or “death ideation.”
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