|Year : 2010 | Volume
| Issue : 2 | Page : 142-144
Suicidal behavior: Assessment of people-at-risk
Scientist 'C' Defence Institute of Psychological Research Lucknow Road ,Timarpur ,New Delhi, India
|Date of Web Publication||28-Nov-2011|
Scientist 'C' Defence Institute of Psychological Research Lucknow Road ,Timarpur ,New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Anand K. Suicidal behavior: Assessment of people-at-risk. Ind Psychiatry J 2010;19:142-4
Updesh Kumar, Manas K. Mandal
Published by: SAGE Publications India Pvt. Ltd., New Delhi
Pages: 378; Price: Rs. 795
Suicide concerns every country and every section of society across the globe. It is a major global health concern for the very fact that it takes tolls over the valued human resource capital and affects the psychological health of even larger number of individuals directly or indirectly. Stress and hardships do not affect everyone alike; some individuals are more vulnerable to suicide than others. It is very pertinent to be able to identify these vulnerable individuals and the circumstances under which their vulnerabilities come to the surface. Next challenge lies in the effective intervention directed towards these individuals. Today, every society is struggling with this problem of managing suicide cases and wholly agrees that timely assessment and predictions are the two pillars on which the suicide prevention rests. This volume comes as a fresh breath to all those dealing with suicides assessment and prediction.
This volume is an extraordinary combination of the experts from the diverse fields ranging from psychiatrist, clinical psychologists, sociologists, and suicidologists spanning across the globe. This unique feature gives universal appeal to this volume. The volume comprises of 15 chapters divided into two sections. Section-I has nine chapters with main focus on risk assessment and related theoretical issues. Section-II comprises of six chapters dedicated to the assessment of people at risk.
Professionals working in the field of suicide risk assessment and prediction have always felt the need for literature with a strong psychometric basis that elucidates suicidal behavior and tendencies in normal population. This volume fulfils the requirements of professionals and students. In chapter one of section-I, author Rory C. O'Connor has explained the etiology and process of suicidal behavior with the help of biopsychosocial model and has further proposed two self-destructive pathways to understand the suicide phenomenon. Situations that stir up suicidal behavior reactions have three components- defeat, no escape, and no rescue, wherein these components become the central motives for suicide. Entrapment and cries of pain (CoP) model has been described very illustratively with the help of excerpts from the suicidal patients and it facilitates enhanced understanding of the phenomenon involved. He has tried to draw the notice of the readers to the importance and need to pay attention at conducting and evaluating evidence-based interventions to revise perfectionism to condense the risk of suicidal behavior.
The next chapter by Morrow, Bryan and Appolonio focuses on the review and integration of empirically based strategies to assess the suicide risk. This chapter talks about core competencies in the assessment and management of suicide risk, which includes clinically balanced and scientifically informed standpoint and ability to translate empirical research into clinical practice. One of the main highlights of the chapter is clear differentiation that it explains in terms of suicide threats, self harm and suicidal attempts and touches upon a very sensitive issue of inconsistent terminology and language related to suicidality. Emphasis has been placed on translating risk assessment into effective management and intervention.
Neurobiological basis of suicidal ideation has been explained very well in detail by the authors, Trivedi and Varma. Biological factors including structural and neurobiological changes have been explained to promote understanding of suicidal behavior as available scales for predicting and assessing ideation are inadequate. Genetic basis of suicidal behavior and the role of different neurotransmitters are discussed.
Problem solving ability is of vital importance while assessing or predictive suicidal behavior. McAuliffe accentuates problem solving process and its impact on Deliberate Self Harm (DSH) with a valid discussion on optional thinking ability and continual DSM. The efficacy of cognitive-behavioral interventions in reducing suicidal behavior is incontrovertibly promising and problem-solving skill training endows with added shield. Theoretical issues concerning suicide and homicide have been discussed in the next chapter that places both these behaviors on a continuum on the basis of cognitive and personality factors. Creating a profile of the individual who is likely to engage in suicide or homicide can provide greater insight into the problem and such understanding would go a long way in checking such behavior in time. For the same purpose, neurological, sociological, and psychological perspectives of suicide and homicide have been explained and discussed.
Next chapter emphasizes the role of culture in suicidal behavior. Assessment of suicidal behavior would be incomplete and shallow if culture is not given its due importance. Suicide can be interpreted differently in different cultures. Authors have explained this by discussing and illuminating various behaviors like physical abuse, parental relations, parental derogation, family support, and drug abuse, etc. Culture defines right from wrong and along with ethnicity plays a crucial role in understanding of the phenomenon. For prevention strategies to be effective and useful there is need to make them culture-sensitive. For different countries, suicide rate is different, but one more thing that is different is the gender differences in suicidal behavior. Next chapter throws light on gender issues and explains quite methodically the why's and how's of gender differences and its implications in assessment. Gender differences are visible in epidemiology, choice of method, mental disorders responsible, protective factors, help-seeking behavior, and socio-economic risk factors. Precise assessment can be done only with the help of gender specific techniques. Author has further emphasized that treatment possibilities too should focus on gender specificity as this can have clinical implications.
Developmental issues have been elaborated methodically by Orden and Miller in the next chapter. Authors are of the opinion that developmental issues are vital while doing risk factor assessment as they may have manifestation at any stage in life in the form of suicidal behavior. Four aspects of suicide risk assessment are discussed where the developmental issues are likely to play a role. These factors are content of information collected, process of collecting that information, context of risk assessment, and finally the decision made with respect to crisis management. Unique factors of each developmental stage and their manifestations at different stages have been elaborated in a sequential manner. One of the factors that impacts or influences the suicide risk behavior is the manner in which suicides are reported. This relatively new area of suicide risk assessment has been discussed in a new light by Kidwai in the following chapter. The author has given significant attention to contagion and cultivation effect of the suicide behavior as she assumes that media coverage of suicide is at the heart of it. She further clarifies that there is an urgent need to educate reporters, journalists, authors, and media personnel about suicide contagion and issues related to it. She has also proposed certain basic guidelines for reporting suicides in media which will prove to be very helpful in checking contagion.
Section-II of the volume shifts its focus from assessment to prediction. This section has six chapters which deal with a varied variety of topics ranging from substance abuse, bipolar disorders, depression to military and Asian adolescents. First chapter of this section written by Mukhopadhyay discusses various tools and tests for suicidal behavior. Author emphasizes that both psychological and psychosocial factors should be evaluated psychologically and systematically as they lead to suicidal behavior. For this very purpose, she has critically reviewed the various suicide risk assessment tools with their scope ranging from ideation to completed suicide. The psychometric properties of each tool have been provided. Students and practitioners will find this very useful and handy. She also opines that it is better to use a set of tests or battery to be able to assess the risk behavior wholly. A very important and pertinent topic of substance abuse is the subject matter of next chapter written by Misra, Sabharwal, and Updesh Kumar. Authors have overviewed the research on the incidents of substance abuse in concurrence with the suicidal behavior. They have also elaborated the literature on comorbidity of substance abuse with other disorders of which personality disorders and depression are central. In the end, they have listed interventions and preventive measures specific to substance users.
Bipolar disorder puts the patients at an amplified risk of suicidal behavior making it the major source of mortality among the patients suffering with this disorder. Pompili et al. have reviewed the relevant literature comprehensively and have discussed the efficacy of various short and long-term interventions for managing this problem. The same has been elaborated by Schaller and Wolfersdorf in the succeeding chapter on depression and suicide wherein they have adopted the base of epidemiological data to explain the association between depression and suicide. They have discussed risk factors differentiating suicidal and non-suicidal depressed patients which are very useful and applicable. Mehlum and Nrugham discuss the issues involved in emergence, maintenance, and prevention of suicidal behaviour in military settings. Authors have focused on environmental and individual risk factors and thereafter protective factors and assessment issues related to military environment. In the last chapter of this section and volume, a relatively new area has been discussed i.e. risk factors for Asian adolescents. Lot has been researched and written for adolescents and suicide risk factor for the western population, but this chapter throws light on rather neglected area of Asian population. Authors have categorized risk factors into psychological, environmental, and socio-cultural and have highlighted the warning signs for suicide and toward the end they have proposed preventive measures and diverse treatment alternatives.
This volume provides useful information to both students and researchers in the field of suicide. This volume has several strengths e.g. the eclectic mix of authors from around the globe, as these authors brings with them their own unique way of looking at the same problem, which enriches the knowledge of the readers. This volume includes 15 chapters divided into two sections from experts in the field who have carried out extensive research and made this volume un-put-downable. Authors from all the continents have contributed and their disciplinary background ranging from sociologist, psychologist, psychiatrists, and suicidologists giving this book a unique flavor. Though these contributors are from different regions, religions, and ethnicity, it only adds to the vastness of ideas thus making it a compelling read. This volume has to its credit doing a very important and tedious job of very unreservedly distinguishing between prediction and explanation for which the chapters have been divided into psychometric assessment and explanatory models. For a long time, students, researchers, and practitioners in the field of suicidal behavior have felt a paucity of literature with a strong psychometric basis that can explain this behavior in normal individuals across lifespan and this gap has been filled by this volume. All the contributors are insightful to epidemiological, cultural, and gender influences surrounding the suicidal behavior. This volume will enhance the understanding, promote interest, influence research, and clarify doubts related to suicide risk assessment among professionals and enthusiastic students who are looking forward to work in this area. I can only conclude by saying that this volume is very useful, balanced, and large in its scope. It is written very systematically using simple and effective language and supplemented by theories, models, and case studies, which makes this volume an absolute stand-out amongst all the other books written on the same subject.