Medical Model Assumption of healthy normality: health is the absence of disease ? it is a natural state that is disturbed only by illness or distress Although this model has worked quite well regarding physical illness, little progress has been made by applying it to psychological health Why? Suffering is basic to human life and may actually define what it means to be human; it is not a disease-like entity The Example of Suicide Suicide is the conscious, deliberate, and purposeful taking of one?s own life It is ubiquitous in human societies It is absent in all other living organisms Limits and flaws of a purely syndromal perspective on human suffering: Suicide is not a disease Many people who commit suicide do not have a well-defined clinical syndrome General Statistics About 12% of the human population will at some time attempt suicide Another 20% will struggle with suicidal ideation and will have a plan Yet another 20% will struggle with suicidal thoughts but without a plan Thus, over 50% of the population will face moderate to severe suicidality in their lifetime Suicide Ideation Thoughts of suicide are very common Suicidal ideation can be passive, involving random thoughts or a desire to die but without a plan to bring about one's death Suicidal ideation can be active and involve a current desire and plan to die Completed Suicides General Population 10.7 suicides per 100,000 Approximately 31,500 completed suicides per year 8th leading cause of death Psychiatric Patients 500 to 1,000 suicides per 100,000 Rate much higher for inpatients than outpatients Highest rate is for those hospitalized for suicide attempt Suicide & Psychiatric Disorders Suicide rates are about equally prevalent in several diagnostic groups (estimates range from 5% to 15%) Depressed patients (bipolar > unipolar; recurrent > single) Schizophrenia Alcoholism Panic disorder Borderline personality disorder Patients with comorbid conditions ? such as substance abuse & personality disorders ? have a greater risk than patients with other major disorders Various studies, based on coroner's reports and retrospective diagnoses, estimate that between 50% and 90% have a psychiatric disorder, with depression being the most common diagnosis Well below 50% of suicide completers have actually been diagnosed with psychiatric disorders prior to their deaths Suicide & Psychiatric Disorders Suicide & Gender In the United States, completed suicides are more common among men than women, but women make more suicide attempts than men Men use more lethal methods - shooting, hanging Women more likely to use pills or cutting Suicide & Other Demographics Whites > African-Americans, Native Americans Unemployed > employed Single, Divorced, Widowed > Married Protestants > Catholics, Jews Gay, lesbian, bi, transgendered > heterosexual Clinical Issues Suicide Prediction refers to the foretelling of whether suicide will or will not occur at some future time, based on the presence or absence of a specific number of factors, within definable limits of statistical probability Suicide Assessment refers to the establishment of a clinical judgment of risk in the very near future, based on the weighing of a large amount of available clinical detail. Risk assessment carried out in a systematic, disciplined way is more than a guess or intuition ? it is a reasoned, inductive process. Suicide Prediction Among individuals hospitalized for a suicide attempt, almost 50% attempt again The risk for completed suicide increases with each suicide attempt The single best predictor of future suicide is a history of hospitalization for suicide attempts Prediction & Prevention There is no evidence that any person or system can accurately predict suicide, especially in the short run when it might be most important There is no empirical evidence that any intervention prevents suicide What Can Be Done? Clinical psychologists must: Conduct a thorough psychiatric evaluation Assess suicide risk Reassess suicide periodically Make confidentiality limits clear to client Consult with other professionals Document, document, document Assessing Suicide Risk Highest risk markers: 1. frequent and intense suicidal ideation (thoughts of killing self) 2. a detailed plan (any plan that is specific is high risk) 3. high lethality (guns or walking in front of busses are more serious than overdosing on Tylenol or slashing wrists) 4. likelihood or availability of plan (includes access to guns or pills) 6. few inhibitors (few reasons not to kill self; no family, no job) 5. low self-control (especially drinking or using drugs - can decide not to kill self but fail to act to reverse events and accidentally kill themselves) SUICIDE: A MULTI-FACTORIAL EVENT Neurobiology Severe Medical Illness Impulsiveness Access To Weapons Hopelessness Life Stressors Family History Suicidal Behavior Personality Disorder/Traits Psychiatric Illness Co-morbidity Psychodynamics/ Psychological Vulnerability Substance Use/Abuse SUICIDE Summary Suicide ideation is very common Suicide attempts are relatively common Suicide completion is relatively rare, even in psychiatric patients The prediction and prevention of suicide completion is difficult
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