Suicide Assessment - Essay Example

Contrary to popular belief, there is a minority of people at risk of committing and an even smaller percentage of those people actually die. With this, it is easy to conclude that predicting suicide is very hard since there are only a few incidents about it. But it is actually easy because the periods of risk can be identified. If several things in one’s life goes wrong all at the same time, the result can be suicide. These are the factors of suicide one should watch out for: the biological factors, predisposing factors, proximal factors and the immediate triggers. The biological factors are familial risk and other health indicators. Predisposing factors are major psychiatric syndromes, substance use and abuse, his personality profile, abuse syndromes and severe mental or neurological illness. Proximal factors are the primary result and reaction of experiencing either familial or predisposing factors. They are hopelessness, intoxication, impulsiveness and aggressiveness, negative expectancy and severe chronic pain. Immediate triggers are those reactions that instantly make the individual change his made towards suicide. These are public humiliation or shame, access to weapons, severe defeat, major loss and worsening prognosis. Once the periods of risk are identified, a specific suicide evaluation will be done to know the degree or magnitude of risk the person is in. The interference that will be done, then, depends on the degree of risk. Identifying the periods of risk in a subject’s life is the predicting part. The assessment part is in response to the identifying part. If there are identified periods of risk and an increase of these periods, then the next step would be evaluation and prevention. There are certain risk factors present in a subject’s period of risk that makes him a primary candidate of a suicide attempt. When one has been in a near lethal suicide attempt already, availability of firearms, written suicide notes are the signs of highest risk people. Having a major mental illness or psychological disorder creates a higher risk. Strong predictors of a suicide in the period of risk in depression are hopelessness, mood cycling, turmoil, unusual thinking and no belief improvement. Weak predictors are those factors that a person may experience but may or may not result to depression, and eventually, suicide. Suicide ideation, on the other hand, is a poor predictor since intent has hidden information still that one must coax out to be understood. A prior suicide attempt is also a poor predictor since most suicide attempts are not that lethal. Suicide, though, can be predicted more accurately by the lethality of any attempt. The more fatal the result of the attempt is, the more the person is at risk for another attempt. There are various assessment tools developed. They have specific features differentiating each other. The specificity identifies the specific risk factor and isolate it. It specifies what type of suicide one is dealing with. The sensitivity is the level of an assessment tool to adapt to the changes and developments in the study of suicide prediction and assessment. The predictive value is the ability of the assessment tool to predict a suicide risk. The reliability and validity is to know the effectivity and accuracy of the assessment tool. This is to know whether or not the results were valid and can be used for a conclusion. One of the difficulties of developing an effective suicide assessment tool is determining how the individual taking it would respond to the questions, whether it will affect him in a negative way, making him more prone to committing the action because of realizing that he is being assessed with it. Another difficulty is making sure that the results are accurate and valid. Making sure that the questions are sensitive enough with regards to determining risk factor and making that there are no direct implications on committing suicide are possible developments in the assessment tools. One of the most popular assessment tools is Beck’s Hopelessness Scale. This assessment tool is a 20-item self-report inventory. This is a type of psychological test in which the patient fills out a survey or a questionnaire. It asks direct questions on symptoms, behaviors and traits associated with depression and hopelessness, which are main risk factors. “Hopelessness increases the risk of suicidal behavior without affecting the degree of suicidal intent. (Blumenthal and Kupfer, 1990). With this assessment tool, the level of hopelessness provides an understanding of the level of risk the patient is in. Dr. Aaron Beck designed this assessment tool designed to measure the three major aspects of hopelessness, which are feelings about the future, loss of motivation and expectations. It is designed for adults 17 – 80 years old. Dowd (1992) concluded that this assessment tool is well-constructed and validated, and with adequate reliability. One of the difficulties in using this assessment tool is the exaggerations that the patient might make their condition seem worse or he may undermine the existing problem and make it look like they don’t have any issues or problems at all. This is the primary challenge of this assessment tool that it limits it to just gauging the changes and severity of the condition. Beck’s Hopelessness Scale is more effectively done with Beck’s Depression Inventory, in which, it measure the severity of depression in the patient. It is designed as a 21-multiple choice self-report inventory for 13 years old and over. It is composed of questions relating to the symptoms of depression such as hopelessness, irritability, guilt and feelings of being punished. It also has items on the physical symptoms such as fatigue, weight loss and lack of interest in sex. The development of Beck’s Hopelessness Scale represented the shift of the healthcare world from a Freudian, or psychodynamic, perspective on depression to a cognitive one, wherein depression is within the mind of the patient, guided by his thoughts. The Adolescent Suicide Interview, which targets the adolescent population is primarily a semi-structured interview which later on developed as a highly structured interview. It aims to determine if there is a suicidal risk present in the adolescent’s behavior, more on dwelling on the major suicidal risk which is depression. It also measures the severity of the suicide ideation, whether or not the real intention is to kill himself, and the severity of suicide attempts the adolescent was engaged in. it also looks into the question whether they were exposed to any suicide attempts or successes and how it affected their perception on it. The questions regarding suicidal ideation and lifetime attempts may imply a greater intent to cessation of life (O’Caroll, et al. 1996). The Adolescent Suicide Interview is more in-depth than that of the self-report inventory of Beck’s Depression and Hopelessness Scale. While Beck’s assessments tools revolve mainly on determining the level of risk involved in the individual’s feelings and behavior, the Adolescent Suicide Interview digs deeper and gives more specific reasons of attempts and ideation. The Adolescent Suicide Interview targets only adolescent children. The interview was structured in a way to coax information out from the adolescent child. It has questions relating to their issues and conflicts as adolescents that would probably explain their behavior, predict suicide attempts at that level and to prevent a rise in attempts and successes. Beck’s assessment tools can be adopted for adults and adolescents since it is a self-report inventory and you just have to choose your answers. It only revolves around specific questions and never being able to draw difference and specifics on what really transpired in the course of his ideation. With these assessment tools, data can be studied and analyzed for use in the prevention of more suicide attempts. The focus here then is to identify specific risk factors that leads to ideation and eventually attempts. If Beck’s assessment tools were developed to gauge the severity of possible risk factors an individual is experiencing and the Adolescent Suicide Interview was to get an in-depth understanding of suicide ideation, the Suicide Intent Scale determines the person’s will to die. This is used for those who survive suicide attempts. This assessment tool measures the severity of the suicide attempt and the person’s intentions to commit suicide. Some attempted suicides were done with little or no intent at all to kill oneself. Other reasons may be to seek attention and just to harm oneself. Others really have no goals or reasons at all. It is a semi-structured self-report inventory that questions the factors why the attempt happened. It assesses the objective characteristics of the attempt such as degree of planning and precautions against discovery. It also measures the subjective characteristics such as expectations of harm, success or failure of the attempt and perceived seriousness of the attempt. It is appropriate not only for adults but also for adolescents. Having this factor measured and analyzed could help determine a person’s psychological and emotional disposition. The suicidal intent scale bears a great impact on the outcome of a study for future preventive measures dealing with such cases. Considering all the factors the suicidal intent scale covers, we can gather relative information based on events of the subject and or patient has been through, and his or her behavioral approach to these events. The suicidal intent scale can also help determine reactions and actions of the subject and or patient to possible future situations. The suicidal intent scale is a very good tool when determining the level of intent a subject may have, and other possible events or situations that may trigger the subject’s intent to shoot off the roof. But there are some limitations to this tool, like determining the subject’s endurance emotionally and mentally of taking in more torments of the situation, another limitation of the suicidal intent scale is how to determine the subject’s and or patient’s transparency and accuracy of their answers. Since the suicidal intent scale is a questionnaire tool given for patients to answer, determining the truth and transparency of their answer can be falsified. In this given situation the outcome or results that will be gathered from the questionnaire may not be accurate and the action plan for the preventive measures may be compromised. Predicting suicide and assessing suicide is very important in the prevention and intervention against the act itself. By using different assessment tools, employing all the necessary tools in determining the risk involved and intent would be very beneficial in knowing how to intervene and prevent the act from happening. Works Cited Blumenthal, S. and Kupfer, D. (1990). Suicide Over the Life Cycle. American Psychiatric Publishing. Dowd, E.T. (1992). "Review of the Beck Hopelessness Scale." Eleventh Mental Measurement Yearbook, 81-82. Goldston, D. (2000). Assessment of suicidal behaviors and risk among children and adolescents. O’Caroll, P., et al. (1996). Beyond the Tower of Babel: a nomenclature for suicidology. Suicide and Life-Threatening Behavior. 26:237-252. Read More