A meta-analysis found that CAMS significantly reduced suicidal thoughts, distress, and hopelessness in comparison to therapy as usual (Swift et al., 2021). According to Jobes (2020), “commonsense recommendations for standard care of suicidal risk” include “(a) identification, (b) assessment, (c) safety planning with lethal means discussion and offer of resources, and (d) the use of caring contact” (p. 155). As part of a safety plan, individuals may include contact information for the Suicide and Crisis Lifeline, available for free 24 hours a day, seven days a week in the United States, at 9-8-8. Services are available in Spanish (988lifeline.org) . In 2021, 46,412 adults in the United States died by suicide, and an estimated 1.7 million people who made attempts to die by suicide. For every suicide death, there were three hospitalizations for self-harm, eight emergency department visits related to suicidal behaviors, 38 self-reported attempts within the past year, and 265 people who, in the past year, seriously considered suicide (Centers for Disease Control & National Center for Injury Prevention, 2023). This offers multiple places to intervene with education, prevention, assessment, and intervention. Survivors of suicide have begun to talk candidly, offering impact statements and recommendations for partnering and treating people who struggle with thoughts of suicide. Recommendations include empathy, active listening, collaborating with patients, curiosity, and avoiding stigmatizing language and behavior (Hom et al., 2021). Additionally, survivors of suicide may experience additional mental health concerns as survivors, including complicated grief, posttraumatic stress disorder, major depressive disorder, and suicidal thoughts and behaviors (ADAA, 2019). If a client presents suicidal ideation and the clinician determines that suicide is an imminent threat to the client’s well-being, a referral for an emergency psychiatric evaluation is necessary (Silverman et al., 2015). In many instances, hospitalization of the client may be required (Silverman et al., 2015). Voluntary hospitalization is preferable to involuntary hospitalization; however, if a client is unwilling to go to the hospital for evaluation and treatment, the clinician may need to proceed with the state’s involuntary commitment procedures (Silverman et
al., 2015). Clinicians should consult their state’s regulations about psychiatric commitment procedures. Procedures for involuntary commitment or assisted outpatient treatment vary from state to state. The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a website that provides information about involuntary commitment at the national or state level. In summary, an in-depth clinical assessment includes an examination of multi-level systems that affect the client’s life. Sometimes, the practitioner will need to obtain the client’s permission to gather additional information from other individuals in the client’s life. By including various perspectives about different aspects of the client’s life, the clinician gains a holistic understanding of the client and their needs. Table 3 lists a number of selected standardized instruments that can also be used to assess depressive symptoms. These tools can be helpful in evaluating the progress and outcome of treatment. (Also see the later section on Outcome Evaluation.) Self-Assessment Question 4 Recommendations for assessment of suicide risk include: (Select all that apply.) a. Assessment at regular primary care appointments. b. Assessment conducted with empathy, active listening, collaboration with patients, curiosity, and avoiding stigmatizing language and behavior. c. Assessment of current suicidal ideas, plans, and intent. d. Assessment of prior self-harm, suicidal ideas, plans, and attempts, including those that were aborted. e. Assessment of psychiatric and trauma history. f. Assessment of mood, level of anxiety, hopelessness, and impulsivity. g. Assessment of psychosocial stressors including lack of employment, social support, terminal medical diagnosis, and personal or relationship problems.
Table 3: Selected Standardized Assessment Instruments Name of Instrument Purpose
Primary Citations
Beck Depression Inventory-II (BDI-II)
A 21-item self-report instrument designed to measure symptoms of depression.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II . Psychological Corporation. Osman, A., Kopper, B. A., Barrios, F., Gutierrez, P. M., & Bagge, C. L. (2004). Reliability and validity of the Beck Depression Inventory—II with adolescent psychiatric inpatients. Psychological Assessment, 16 (2), 120- 132. http://dx.doi.org/10.1037/1040-3590.16.2.120 Radloff, L. S. (1977). The CES-D Scale: A self-report report depression scale for research in the general population. Applied Psychological Measurement, 1 (3), 385-401. http://dx.doi. org/10.1177/014662167700100306 Saracino, R. M., Cham, H., Rosenfeld, B., & Nelson, C. J. (2018). Confirmatory factor analysis of the Center for Epidemiologic Studies Depression Scale in oncology with examination of invariance between younger and older patients. European Journal of Psychological Assessment . http://dx.doi.org/10.1027/1015-5759/a000510
Center for Epidemiological Studies Depression Scale (CES-D)
A 20-item self-report tool that measures major dimensions of depression experience within the last week. Ages 6 through adult.
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