to help clarify various issues of concern to mental health providers, coroners, and researchers. Each of these acts, with the exception of suicide and suicidal thoughts, can be further clarified as being with injuries, without injuries, or with fatal outcome. The intent to kill oneself is a foundational aspect of defining an act as suicide-related. For example, if a person were to die as a consequence of an instrumental suicide-related behavior , as defined in Table 1 (e.g., a knife wound self- inflicted for the purpose of mood regulation rather than death), the death would be classified as accidental rather than suicide because the intent to die is missing. The goal of developing a uniform nomenclature is to increase the ability of mental health providers, researchers, epidemiologists, Table 1: Nomenclature Describing Suicidal Behavior Suicide
and policy makers to better communicate with each other and to better research and intervene with at-risk populations. According to the Navy and Marine Public Health Center (n.d.): The knowledge and use of appropriate terminology when dealing with issues related to suicide helps to reduce stigma associated with help seeking. Appropriate use of terminology by the healthcare team and those referring individuals for care promotes and facilitates appropriate and timely care of at-risk individuals and those affected by suicide and demonstrates respect and sensitivity to the experiences of those affected by suicide.
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.
Suicide attempt with injuries
Suicide attempt 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. Suicidal act 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. Instrumental 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). 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. Suicide threat 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. suicide- related behavior Suicide- related behavior
Suicidal ideation
Any self-reported thoughts of suicide (i.e., passive ideation) or engaging in suicide-related behavior (i.e., active ideation).
Non-suicidal self-injury
Self-inflicted injury that is engaged in without suicidal intent.
Note . Based on terms defined in Glenn et al. (2020) and Frey et al. (2020).
IDENTIFYING CLIENTS AT RISK: IT’S NOT SUICIDE PREDICTION
In a classic study attempting to identify which clients would complete suicide within 5 years based on known risk factors, Pokorny (1992) concluded “that we do not possess any item of information or combination of items that permit us to identify to a useful degree the particular persons who will commit suicide, in spite of the fact that we do have scores of items available, each of which is significantly related to suicide” (p. 127). Unfortunately, though the situation today is better, we still have a long way to go (Large et al., 2017). A recent examination of the predictive power of self- injurious thoughts and behaviors in the prediction of suicidal ideation and behavior came to a similar conclusion. “When considered in the context of the extremely low prevalence
of suicidal thoughts and behaviors and the clinical demands that call for very short prediction timeframes, prior self-injurious thoughts and behaviors may not improve prediction much beyond chance levels” (Ribeiro et al., 2016, p. 234). Because of the challenges of predicting suicide outcomes, the provider’s primary task instead is to identify those persons most at risk for suicide, and then to appropriately respond to that immediate risk with proper assessment and treatment (Chu et al., 2015). It is important to remember that the notion of assessing risk should not be confused with actually predicting suicide. It also should be remembered that risk assessment, although imperfect, likely saves lives and should be done rigorously.
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Book Code: SWUS1525
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