● Past behavior : The patient’s past suicide behavior is the strongest predictor of future attempts. Evaluate past self- injury and history of suicide attempts (method, estimated date, intent). Ask the patient, “Have you ever tried to hurt yourself?” or “Have you ever tried to kill yourself?” If yes, ask, “How? When? Why?” and assess intent: “Did you think [method] would kill you?” “Did you want to die?” In youth patients, intent is as important as lethality of method. Ask, “Did you receive medical/psychiatric treatment?” ● Symptoms : Assess the presence of any symptoms that are linked to suicidal behavior: ○ Depression : “In the past few weeks, have you felt so sad or depressed that it makes it hard to do the things you would like to do?” ○ Anxiety : “In the past few weeks, have you felt so worried that it makes it hard to do the things you would like to do or that you feel constantly agitated/on edge?” ○ Impulsivity/recklessness : “Do you often act without thinking?” ○ Hopelessness : “In the past few weeks, have you felt hopeless, like things would never get better?” ○ Anhedonia : “In the past few weeks, have you felt like you couldn’t enjoy the things that usually make you happy?” (outpatient BSSA) ○ Isolation : “Have you been keeping to yourself more than usual?” (outpatient BSSA) ○ Sleep pattern : “In the past few weeks, have you had trouble falling asleep or found yourself waking up in the middle of the night or earlier than usual in the morning?” ○ Appetite : “In the past few weeks, have you noticed changes in your appetite? Have you been less hungry or more hungry than usual?” (outpatient BSSA) ○ Irritability : “In the past few weeks, have you been feeling more irritable or grouchier than usual?” ○ Substance and alcohol use : “In the past few weeks, have you used drugs or alcohol?” If yes, ask, “Which ones? How much?” ○ Other concerns : “Recently, have there been any concerning changes in how you are thinking or feeling?” ● Social support & stressors : This section is included in the outpatient Primary Care/Specialty Clinics section of BSSA (NIMH, 2018). For all questions below, if patient answers yes, ask them to describe: ○ Support network : “Is there a trusted adult you can talk to? Who? Have you ever seen a therapist/counselor?” If yes, ask, “When?” ○ Family situation : “Are there any conflicts at home that are hard to handle?” SOS Signs of Suicide program SOS Signs of Suicide is a universal program that promotes the idea that suicide is related to mental illness rather than a normal reaction to emotional stress or distress. This program includes suicide awareness, suicide screening and educational interventions. It uses video and guided classroom discussions among students to learn how to acknowledge the signs of suicide displayed by their peers and to take those seriously. Students then learn how to let their peers know that they care about them and how to report these findings to an adult (Schilling, Aseltine & James, 2016). The second part of the SOS Signs of Suicide program is the screening component that utilizes the Brief Screen for Adolescent Depression (BSAD) tool. Students identified using this tool are encouraged to seek further help. A 2016 study by Schilling, Aseltine, & James replicated and extended previous evaluations of the SOS prevention program in a high school population using a more rigorous pre-test/
○ School functioning : “Do you ever feel so much pressure at school (academic or social) that you can’t take it anymore?” ○ Bullying : “Are you being bullied or picked on?” ○ Suicide contagion : “Do you know anyone who has killed themselves or tried to kill themselves?” ○ Reasons for living : “What are some of the reasons you would NOT kill yourself?” Interview the patient together with their parent or guardian. If the patient is 18 or older, ask their permission for the parent to join. Check with state law because in some states the age of consent in health matters may be younger than 18. Say to the parent, “After speaking with your child, I have some concerns about his/her safety. We are glad your child spoke up as this can be a difficult topic to talk about. We would now like to get your perspective.” Reference specific information gleaned from the ASQ: “Your child said (reference positive responses on the ASQ). Is this something he/she shared with you?” Ask about the parent/guardian’s knowledge of past behavior: “Does your child have a history of suicidal thoughts or behaviors that you’re aware of?” If yes, say, “Please explain.” Ask the parent/guardian about the presence of symptoms linked to suicidal behavior: “Does your child seem sad or depressed? Withdrawn? Anxious? Impulsive? Hopeless? Irritable? Reckless?” Ask about the youth’s safety: “Are you comfortable keeping your child safe at home? How will you secure or remove potentially dangerous items (guns, medications, ropes, etc.)?” Finally, ask the parent guardian for any other concerns: “Is there anything you would like to tell me in private?” Risk and intervention disposition After completing the assessment, choose the appropriate disposition: ● Emergency psychiatric evaluation: Patient is at imminent risk for suicide (current suicidal thoughts). Urgent/STAT page psychiatry; keep patient safe in ED. ● Further evaluation of risk is necessary: Request full mental health/safety evaluation in the ED. ● No further evaluation in the ED: Create safety plan for managing potential future suicidal thoughts and discuss securing or removing potentially dangerous items (medications, guns, ropes, etc.). ● Patient can be sent home with mental health referrals. ● No further intervention is necessary at this time. Finally, provide resources to patients and parents/guardians. These would include all local support numbers and may include: ● Lifeline: 1-800-273-TALK (8255), En Español: 1-888-628-9454 24/7 Crisis Text Line: Text “HOME” to 741-741. post-test randomized control design than used in previous SOS evaluations in high schools. SOS was presented to an ethnically diverse group of ninth-grade students in technical high schools in Connecticut. After controlling for the pre-test reports of suicide behaviors, exposure to the SOS program was associated with significantly fewer self-reported suicide attempts in the three months following the program. Ninth-grade students in the intervention group were approximately 64% less likely to report a suicide attempt in the past three months compared with students in the control group. Similarly, exposure to the SOS program resulted in greater knowledge of depression and suicide and more favorable attitudes toward: (1) intervening with friends who may be exhibiting signs of suicidal intent and (2) getting help for themselves if they were depressed or suicidal. In addition, high-risk SOS participants, defined as those with a lifetime history of suicide attempt, were significantly less likely to report planning a suicide in the three months following the program compared to lower-risk participants. Differential
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Book Code: PYCA1423
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