Six questions you can ask a loved one to help screen for suicide risk

September 12, 2018 by Andres Pumariega, The Conversation
6 questions you can ask a loved one to help screen for suicide risk
Death by suicide isn’t always related to depression. Relationship, job and legal problems can give rise to feelings of hopelessness. Six screening questions may help. Credit: PHotograhee.eu

Suicide rates in the United States have increased by 25-30 percent since 1999. This is particularly true for youth ages 12-24, with increases of approximately 30 percent over the same period. In Alachua County, Florida, where I teach and practice at the University of Florida, the base rate for suicides among youth ages 12-17 had been about five per 100,000 for many years, below the base national rate of 13 per 100,000. However, in the year 2017 that rate of completed suicides increased to 27 per 100,000, and for 2018 we are at a pace that will likely equal 2017.

While we mental health professionals know that depression and other mental and emotional disorders contribute to deaths by and having thoughts or plans for suicide, life stressors are more often listed as causes, especially since most people do not access mental health services. These include such things as relationship problems, job and financial problems, substance abuse and life crises. Suicides also take approximately twice as many lives as homicides, which garner much more attention.

Our society is now aware that we are facing a national epidemic. The challenge is to identify and serve individuals who are at risk of attempting and completing suicide before that tragic outcome. I have been part of important work over the past few years that offers hope for early identification and prevention, including at a population level.

Curbing a heartbreaking trend

Health care organizations have established a national patient safety goal of reducing suicide as part of receiving , particularly in hospitals, promoted by The Joint Commission, a nonprofit that certifies health care programs and professionals.

While at Reading Hospital and Medical Center in Reading, Penn. as chair of psychiatry from 2006 until 2011, I was approached by the nursing leadership about tools and processes for suicide screening for patients being admitted, consistent with that national safety goal. Searching the literature, I identified the Columbia Suicide Severity Rating Scale (C-SSRS) as a possible tool. It had been primarily developed Dr. Kelly Posner as a tool to screen for suicidality in medication research trials. It is now mandated by the FDA for psychiatric, neurological and endocrinological trials. This came after concerns about suicidal thoughts and at-risk behaviors being associated with the use of such medications.

The Columbia Suicide Severity Rating Scale was unique in having predictive value for future suicide attempts, but I found it was cumbersome to administer as a brief screener. Being convinced of the potential for the tool, I approached Dr. Posner about developing an abbreviated screening version. She agreed to the proposal, and my research assistant, Udema Millsaps, and I proceeded to develop a brief, six-item version. Five questions that relate to having ideas about suicide and one question on prior suicidal attempts met Dr. Posner's approval.

In 2009, we went on to implement the first screening C-SSRS, embedded in the initial nursing assessment within the electronic medical record, for all patients being admitted to Reading Hospital. We also developed a response algorithm for either referral to or urgent safety precautions and psychiatric response during the hospitalization. We also trained over 600 nurses on its administration, with the assistance of Dr. Posner. The results, including both feasibility and outcomes, were very encouraging, including reliability of administration and effective identification of patients at risk, and we presented them at national meetings.

Since that time, I similarly worked with nursing leadership at Cooper University Hospital during the years 2011-2013 in implementing systematic suicide screening using the screening C-SSRS as part of the initial nursing assessment, much as was the case with Reading Hospital. By that time, Dr. Posner had done further work on the scoring of the screening C-SSRS and had developed a new official version, which we happily adopted. Both Reading Hospital and Cooper University Hospital were early adopters of this novel approach to suicide prevention.

However, the team at Columbia has gone much further in promoting the implementation of the screening C-SSRS, now recommending it for broad use in many settings, including our military as well as by the general public. There is now a community version that is recommended to be used by concerned friends and family members if they identify someone close to them as having some risk for suicide.

Dr. Andres Pumariega discusses the screening tool for suicide.
The six questions

The first five questions are about a person's feelings over the past month. These questions can be asked of people ages eight and older. They need to be included within an emphathic conversation indicating concern for the person, and asked in a nonalarming, matter-of-fact manner.

  1. Have you wished you were dead or wished you could go to sleep and not wake up?
  2. Have you actually had any thoughts about killing yourself?If the loved one answers "yes" to question 2, ask questions 3, 4, 5 and 6.If the person answers "no" to question 2, go directly to question 6.
  3. Have you thought about how you might do this?
  4. Have you had any intention of acting on these thoughts of killing yourself, as opposed to you have the thoughts but you definitely would not act on them?
  5. Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
  6. Always ask question 6: In the past three months, have you done anything, started to do anything, or prepared to do anything to end your life?

Examples you could mention would be: Have you collected pills; obtained a gun; given away valuables; written a will or suicide note; held a gun but changed your mind; cut yourself; tried to hang yourself.

The potential of this work has only touched the surface of this critical problem, and it has many broader applications and opportunities for implementation. These include combining the screening C-SSRS with training on risk surveillance for implementation by teachers, counselors and student organizations, ranging from middle school through the college levels. This especially includes minority and culturally diverse populations, where there have also been major increases in numbers of suicide attempts.

I am currently pursuing such opportunities to make this tool as well as awareness about suicide widely available with the ultimate goal of saving young lives.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). The website is National Suicide Prevention Lifeline.

Explore further: Older adults may need better follow-up after ER screenings for suicide

Related Stories

Older adults may need better follow-up after ER screenings for suicide

August 9, 2017
According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides ...

Know the warning signs of suicidal thoughts

September 12, 2016
(HealthDay)—Family, friends and acquaintances can play a key role in suicide prevention by being alert for signs and taking action to help someone who may be struggling, a mental health expert says.

Scale assessing suicidal ideation saves lives through high predictive validity and use of common language

November 9, 2011
(Medical Xpress) -- Work to advance suicide prevention and increase the reliability of suicide risk assessment received a significant boost this week through findings of a new study of the Columbia Suicide

Suicide and genetics: a complicated association

April 22, 2017
Dear Mayo Clinic: Why does it seem that suicide tends to run in families? Does it have anything to do with genetics?

Lingering risk of suicide after discharge from psychiatric facilities

May 31, 2017
A study that synthesized more than 50 years of research into suicide rates for patients after discharge from psychiatric facilities suggests the immediate period after discharge was a time of marked risk and that the risk ...

Psychotic experiences put kids at higher suicide risk

August 30, 2017
Otherwise healthy people who experience hallucinations or delusions are more likely to have later suicidal thoughts or attempts, an international study has found.

Recommended for you

MDMA makes people cooperative, but not gullible

November 19, 2018
New research from King's College London has found that MDMA, the main ingredient in ecstasy, causes people to cooperate better—but only with trustworthy people. In the first study to look in detail at how MDMA impacts cooperative ...

Exploring the genetic contribution to suicide risk

November 19, 2018
Researchers at University of Utah Health identified four gene changes that occur more frequently in people who died by suicide that may point to increased risk in vulnerable individuals.

Study measures effectiveness of online communication tools in combatting depression among socially isolated seniors

November 19, 2018
Imagine your family has moved across the state or across country. You're retired, and your spouse has passed away. Lacking the social connections previous generations once found in church or fraternal organizations, it doesn't ...

Response to daily stressors could affect brain health in older adults

November 19, 2018
Taking typical daily annoyances such as a long wait at the doctor's office or a traffic jam on the freeway in stride may help preserve brain health in older adults, while emotional reactions could contribute to declines in ...

In-person, but not online, social contact may protect against psychiatric disorders

November 19, 2018
In-person social contact seems to offer some protection against depression and PTSD symptoms, but the same is not true of contact on Facebook, suggests a study by Veterans Affairs Portland Health Care System and Oregon Health ...

'Boomeranging' back to a parents' home negatively affects young adults' mental health

November 19, 2018
The number of young adults living in their own household has dropped dramatically in the last decades in the United States for a number of economic and social reasons. In a study that will soon be published in the peer-reviewed ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.