Improving suicide risk assessment in a managed-care environment

This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration.     

The protective role of parental involvement in adolescent suicide

This study of 2,722 adolescents aged 14-18 years explored whether parental involvement can protect against adolescent suicide attempts. Compared to their counterparts suicide attempters were more likely to have been in trouble with the police, to report lower levels of parental interest and academic motivation, and to report suicidal ideation and using alcohol or an illegal drug when they feel stressed. They were also less likely to reside with both parents. The association between parental involvement and suicidal behaviour was not stronger for sons than for daughters or for adolescents who had experienced family disruption than for those who grew up in two-parent families.     

The impact of suicide prevention centers on the suicide rate in the Canadian provinces

A study by Leenaars and Lester (1995) found that suicide prevention centers in the provinces of Canada in 1985 had a preventive, but nonsignificant, impact on the suicide rates of the provinces. The present study replicated that study for 1994-1998 and found a similar preventive impact, although weak, of suicide prevention centers on the provincial suicide rates.     

The pattern of suicide in Pakistan

There is paucity of information on suicide from Pakistan, an Islamic country in which data collection poses formidable challenges. A variety of social, legal, and religious factors make reporting and diagnosing suicide difficult. Paradoxically, incidents of suicide are regularly reported in newspapers in Pakistan. In the absence of other means these reports serve a useful, though basic information source for suicidal deaths. A 2-year analysis of all such reports in a major newspaper in Pakistan showed 306 suicides reported from 35 cities. Men (n = 208) outnumbered women by 2:1. While there were more single than married men, the trend was reversed in women. The majority of subjects were under 30 years of age and "domestic problems" was the most common reason stated. More than half the subjects used organophosphate insecticides, while psychotropics and analgesics were used infrequently. The study challenges the widely held belief that suicide is a rare phenomena in an Islamic country like Pakistan, and underscores the need for more culture specific research on this important public health problem.     

Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature

The prediction of suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. This paper provides an overview of the inpatient suicide literature to date focusing on two particularly salient themes: Long term and short term prediction of suicide. Since the concept of short-term suicide risk dominates clinical practice, issues in relation to dynamic risk factors are emphasized.     

The impact of suicide on the family

Little research has examined the consequences of a suicide for social or family networks. Because suicide occurs within families, the focus on the aftermath of suicide within families is an important next step to determine exactly how to help survivors. In this article, we review and summarize the research on the impact of suicide on individuals within families and on family and social networks. We begin with a discussion of family changes following suicide. Next, we discuss the effects of suicide on social networks overall and responses of children and the elderly to a suicide in the family. Finally, we identify key issues that remain to be resolved in family survivor research and make recommendations for future studies.