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1
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- Kelly Posner, Ph.D.
- Maria A. Oquendo, M.D.
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2
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- Lack of agreement on common terminology
- In clinical descriptions of suicidal acts
- In research descriptions of suicidal acts (even among experts in
suicidal behavior)
- Importance of reliability (all define/assess the same way) and validity
(some truth to dfn)
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3
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- A self-injurious act committed with at least some intent to die.
- Intent does not have to be explicit. Eg: patient denies intent to die,
but thought that the behavior could be lethal. Intent can be inferred.
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4
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- Interrupted Attempt: individual
is stopped by an outside circumstance from starting the self-injurious
act
- Aborted Attempt: individual takes steps towards making a suicide
attempt, but stops himself before engaging in any potentially
self-destructive behavior
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5
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- Presence of intent to die differentiates suicidal acts from self-injury
- -Determine whether self-injurious act was thought of as a means of
causing or facilitating death
- -Support for validity of using intent to define suicidality: Completed
suicide predicted by previous intent measures (Beck et al, 1989)
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6
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- Teenage girl reported mother was being cruel and neglectful and she
wanted to escape from mother’s home. States she researched lethal doses
of ibuprofen to make sure she took an amount that would not be
life-threatening. Took 6, feeling certain it was not enough to kill her,
she definitely did not want to die, only to escape from mother’s home.
Taken to ER and then admitted to psych. hospital
- Person described 12 incidents of cutting himself. States he did this only “to relieve
tension” and “to play with danger to see how far I would go” and no part
of him wanted to die. Thought
about it for hours before acting on the urge and felt relieved of
tension afterwards. Did not feel
pain while cutting self.
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7
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- Reliability
- excellent reliability (kappa= .97) utilizing classification system
in NIMH- funded treatment,
biological, and genetic trials
- Multi-site reliability with other centers in family genetic studies and
treatment of adolescent suicide attempters trial
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8
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- Individuals classified as suicide attempters have as much as 2.5X risk
of future attempts or completions (Dorpat, 1967, Nordstrom, 1995,
Oquendo, in press)
- Interrupted attempters are reported to be 3X more likely to commit
suicide than uninterrupted attempters (Steer et al 1988)
- Aborted attempters are at risk for eventual attempts and were more
likely to have made an actual attempt in the past (Marzuk et al 1997)
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9
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10
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11
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- Develop guidelines as to how to better capture data, enabling
appropriate classification of suicidality:
- Utilization of research assessment tools
- (what questions to ask, how to ask, and what measures aid this)
- Consistency of Nomenclature and Classification
- Improved, More Valid Identification and
- Documentation Of Suicidality
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Notes
