Protective Factors as Predictors of Suicide Risk Among Graduate Students

The purpose of this study was to examine protective factors as predictors of suicide risk among graduate students (n = 413) at a large midwestern university. Using binary logistic regression, the authors assigned students to risk classifications (i.e., nonrisk group or suicide risk group). Results indicated emotional stability as the strongest predictor for participants’ placement into the nonrisk or suicide risk group. The authors discuss implications for counselors and directors of college counseling centers, as well as directions for future research.     

The Current Status of Graduate Training in Suicide Risk Assessment

Directors and coordinators (n = 75) of graduate programs in school psychology approved by the National Association of School Psychologists (NASP) were surveyed regarding their training practices in suicide risk assessment. Respondents viewed the assessment of suicide risk as an important part of graduate instruction, and most believed that students completing training at their institutions would be adequately prepared to perform this task. Almost all directors indicated that a portion of class lectures was dedicated to addressing child/adolescent suicide risk assessment, and students were reportedly exposed to this topic in multiple courses, particularly those associated with practicum and internship. Students in doctoral and nondoctoral programs received comparable training and were judged to be equally prepared to perform suicide‐related professional activities in the schools. Gaps in training were revealed involving instruction in the use of quantitative measures of risk, large‐scale suicide prevention efforts, interventions with suicidal youth, and postvention activities.     

The Epidemiology of Suicide Among Students at Colleges and Universities in the United States

All published studies and selected unpublished reports on the incidence of suicide among students at colleges and universities in the United States are reviewed. Compared with studies relying upon official (i.e., governmental) records of suicide, studies relying on informal sources are found to underestimate the incidence of student suicide by about 30 percent. Both sources of data, however, indicate that the incidence of student suicide is significantly and dramatically lower (about 46 percent) than that of non-students. For female students it is only marginally lower (about 91 percent). Institutional size and prestige are not significantly related to the incidence of student suicide, nor is class standing. The presence of psychosis is the most discriminating individual difference variable, increasing the risk of suicide by a factor of 200 over baseline rates in the student population. Contact with campus mental health services is also associated with a significant (six fold) increase in risk for suicide. Depression is upiquitous and signals only a doubling of risk for suicide among students. Method of suicide is a particularly noteworthy variable. Most importantly, male students are half as likely as males generally to employ the most common means of suicide, firearms. The same trend is found for female students. There is suggestive evidence that student suicides occur more frequently than would be expected during the months of September, January and March. The incidence of student suicide is significantly elevated during weekdays (Monday-Thursday. Student suicide occurs disproportionately often during the midnight to 6:00am period, but this finding is only suggestive and may not be a contrast with non-student suicides. The implication of these findings for the prevention of student suicide are briefly discussed. Suggestions for further epidemiologic studies of student suicide are made.     

School psychologists and suicide risk assessment: Role perception and competency

As the second leading cause of death for adolescents, suicide is a major concern for school personnel. School psychologists' training in mental health makes them well-positioned to lead in suicide prevention efforts; however, studies have shown a lack of preparedness in crisis intervention and, more specifically, suicide risk assessment. This study surveyed practicing school psychologists (N = 92) to explore their perception of both their role and competency in suicide risk assessment. Suicide risk assessment was defined as a broad term pertaining to any measures taken in suicide prevention, intervention, or postvention. The majority of school psychologists reported having a primary role at the tertiary level (i.e., intervening with a student identified as needing help). Participants indicated lacking adequate graduate preparation; however, most participants were confident in their knowledge of suicide and suicide risk assessment and were comfortable identifying and intervening with a student who is suicidal. Implications for practice and directions for future research are discussed.     

Suicide:

The purpose of this article is to provide a framework for training the residence hall RA as a suicide interventionist. It is important that the RA have the necessary information and skills to recognize, evaluate and refer students who are at risk for taking their own lives. In addition, this article discusses what the RA must known in order to assist the survivors of unsuccessful suicide attempts or those who are left after a completed suicide. As an itnerventionist, the RA is not a counselor or therapist but someone who is able to assist the suicidal student in securing professional assistance and being of support during the process of therapy.     

AN EXPLORATORY STUDY OF SUICIDE RISK ASSESSMENT PRACTICES IN THE SCHOOL SETTING

Suicidal behavior in children and youth continues to be a major public health problem in the United States. School personnel have a legal and ethical obligation to recognize and respond to the mental health needs of their students and to take steps to ensure their safety. In this exploratory study, suicide risk assessment practices of three large school districts were examined. More than 3,400 suicide risk assessments were conducted in these districts during the 3 years considered. The results indicate that all three districts have implemented suicide prevention programs that include risk‐assessment practices in an effort to reduce suicidality. Suicides risk assessments were conducted with at least one child in each grade from kindergarten through 12^th in each district, occurring most frequently at the middle school level. Differences by gender were noted in terms of level of risk and hospitalizations, but no significant differences were observed based on race/ethnicity. These risk assessment efforts of these three districts appear to be promising in preventing suicides: none of the students who were assessed went on to commit suicide. Implications for school‐based practices and training are discussed.     

Preparing for the Inevitable: Training Social Workers to Cope with Client Suicide

Little attention has been given to educating and training social work students and professionals about working with suicidal clients. This article summarizes the literature on client suicide and the professional social worker, as well as presents results from a mixed methods study, which utilized both qualitative and quantitative data collected from a national study on client suicide among social workers. The results indicate that 55% of social workers will experience at least one client suicide attempt and 31% will experience a client suicide completion during the course of their career. Additionally, less than 50% of the social workers surveyed received previous training or education about client suicide in their MSW programs. Suggestions from social workers for the content of training classes on client suicide are included. Implications for practice and research are also discussed.     

Improving the lives of students,gay and straight alike: Gay‐straight alliances and the role of school psychologists

Lesbian, gay, bisexual, and transgender (LGBT) students face many risk factors every day when they enter their school's door. These students often fear for their safety at school, are victimized, have academic difficulties, suffer from issues with their identity development, and are at risk for suicide. School‐based Gay‐Straight Alliances (GSAs) have been shown to reduce the risk for LGBT students in these areas. School psychologists are in a unique position to be instrumental in alleviating many of the problems LGBT students face every day by being a GSA advisor. This article reviews the literature on LGBT student risk in terms of the benefits of a GSA and guides school psychologists on how to start and advise a GSA in their schools.     

Comparing policies for children of parents attending hospital emergency departments after intimate partner violence,substance abuse or suicide attempt

To improve identification of child maltreatment, a new policy (‘Hague protocol’) was implemented in hospitals in The Netherlands, stating that adults attending the hospital emergency department after intimate partner violence, substance abuse or a suicide attempt should be asked whether they care for children. If so, these children are referred to the Reporting Center for Child Abuse and Neglect (RCCAN), for assessment and referrals to support services. An adapted, hospital-based version of this protocol (‘Amsterdam protocol’) was implemented in another region. Children are identified in the same manner, but, instead of a RCCAN referral, they are referred to the pediatric outpatient department for an assessment, including a physical examination, and referrals to services. We compared results of both protocols to assess how differences between the protocols affect the outcomes on implementation, detection of child maltreatment and referrals to services. Furthermore, we assessed social validity and results of a screening physical examination. We included 212 families from the Amsterdam protocol (cohort study with reports by pediatric staff and parents) and 565 families from the Hague protocol (study of RCCAN records and telephone interviews with parents). We found that the RCCAN identified more maltreatment than pediatric staff (98% versus at least 51%), but referrals to services were similar (82% versus 80% of the total sample) and parents were positive about both interventions. Physical examination revealed signs of maltreatment in 5%. We conclude that, despite the differences, both procedures can serve as suitable methods to identify and refer children at risk for maltreatment.     

A case for routine involvement of threat assessment and management teams with college students at risk for suicide

ABSTRACT

Institutions of higher education and their counseling centers are under intense pressure to prevent student suicide. This article proposes that routinely using threat assessment and management teams in working with suicidal students would add value to existing suicide prevention efforts. The unique features of threat assessment and management provide several advantages over traditional clinical intervention. First and foremost, the majority of students who die of suicide do not seek services from campus counseling centers. These students may, nonetheless, come to the attention of campus constituents in a number of ways and may readily be referred to a threat assessment and management team. For students who are clients of the counseling center, a campus should still activate a threat assessment and management process. In this way, threat assessment and management may be useful for students who refuse to seek help as well as in providing assistance when students are engaged in treatment. Nonetheless, higher education in general and counseling centers in particular have not engaged in a standard practice of involving threat assessment and management teams with students who present at risk for suicide. Limitations to clinical approaches for suicide prevention are reviewed in contrast with the complementary advantages of threat assessment and management as applied to suicidal students. Regularly including threat assessment and management in working with suicidal students in higher education may provide synergy in improving the likelihood of desirable outcomes in preventing suicides.     

大学生自杀行为及预防与干预对策

近几年来，在校大学生自杀事件频频发生，大学生已成为自杀的高危人群。其危害已经引起了社会各界的普遍关注。成为高校无法回避的难题之一。文章对大学生自杀现象进行了分析，并在此基础上提出大学生自杀的预防和干预对策。     

Influence of childhood abuse and neglect subtypes on late-life suicide risk beyond depression

The association of childhood maltreatment and suicide has been extensively examined within the population. Depression figures as a main cause for the elevated suicide rate in advanced ages and is often related to childhood maltreatment. The purpose of the present study was to examine the relationship between childhood maltreatment subtypes and suicide risk, testing geriatric depression as a moderator. This is a cross-sectional study looking at a sample of 449 individuals 60 year s old or older from the Multidimensional Study of the Elderly of Porto Alegre Family Health Strategy, Brazil (EMI-SUS/POA). Childhood maltreatment (Childhood Trauma Questionnaire), geriatric depressive symptoms (Geriatric Depression Scale), and suicide risk (Mini International Neuropsychiatric Interview) were assessed. The subtypes of childhood abuse and neglect were significantly associated with suicide risk. In the multivariate analysis, controlling for age, gender, income, marital status, ethnicity, smoking, and geriatric depression symptoms, all trauma subtypes remained associated with suicide risk with the exception of physical neglect (EA = 3.65; PA = 3.16; SA = 5.1; EN = 2.43; PN = 1.76). The present study showed that childhood maltreatment subtypes predicted suicide risk, and geriatric depression does not directly mediate this relation.     

构筑三位一体的大学生自杀预防体系

为应对日益严峻的大学生自杀问题,理论与实践界进行了积极探索。心理咨询致力于矫正、治疗可能导致自杀行为的心理问题,生命教育以珍爱生命、提升生命品质为宗旨,在预防大学生自杀中彰显出独特优势和显著成效,但同时也各有其局限与难为之困境。大学生自杀之根源与对其施以制约和影响的社会情境密不可分。在心理咨询、生命教育预防基础上拓展与深化,增强大学生在风险社会中的平等体验与积极的自我建构,是有效预防大学生自杀的"治本"之举。为此,政府和社会应促进高等教育资源配置公平,推进大学生公平就业,完善与改进贫困大学生资助体系;大学生要努力提升自身专业素质,提升体悟生命的内在教养,追寻"自我同一性"。     

“高自杀风险”大学生认同保密例外的说服策略

"高自杀风险"大学生不认同保密例外是高校心理咨询实践中的难题,严重伤害咨访关系,不利于日后开展心理援助。"高自杀风险"大学生不认同保密例外与危机状态下的心力委顿、污名化与病耻感、对学校和家长的不信任这三个方面有密切关系。心理咨询师在实施保密例外之前要按照知情同意的原则,选择合适时机,从抑郁发作的危险性、社会支持的重要性、心理危机干预管理制度、保密例外的范围和内容这几个方面来说服"高自杀风险"大学生接受并认同保密例外。     

大学新生适应期的心理障碍及调适

进几年来,大学新生因心理障碍而导致休学、退学、自杀等现象屡见不鲜,且患有心理疾病的人数每年都在增加,论文将阐述大学新生在适应期心理障碍的主要表现形式及解决这些心理障碍的调适方法。     

24例精神病人院外自杀死因分析与预防

目的：通过分析调查精神病人院外自杀死亡的各种因素,降低自杀死亡率．方法：回顾性调查研究2000-2003年间经住院治疗出院后的院外自杀死亡的24例精神病人的病种、病程、自杀方式、年龄、季节、文化程度及各种生理、心理、社会因素．结果：自杀以男性多见,年龄在20-30岁和40-50岁两个年龄段,文化程度以初中及以下多见,住院2-3次多见,职业以农民多见,疾病种类以精神分裂症多见,自杀方式以服大量抗精神病药多见,自杀春夏季高于秋冬季．自杀因素有社会环境、家庭、疾病影响,药物副反应及其它等．结论：精神病人院外自杀预防应以社会、家庭、医生共同参与帮助为较好途径,早期发现,早期干预和治疗是减少自杀死亡的关键．     

Filicide–suicide ideation among Taiwanese parents with school-aged children: Prevalence and associated factors

This study explored the prevalence of filicide–suicide ideation among Taiwanese parents with school-aged children. Multiple risk factors associated with filicide–suicide ideation were assessed, and the potential effect of traditional family values was evaluated. A random sample of 1,564 parents was recruited from 21 elementary schools in a rural area of Taiwan. Potential risk factors, including demographics, family finance, psychological maladjustment, family interaction, and cultural beliefs, were further examined using a hierarchical logistic regression. Overall, 14.6% of the respondents reported having filicide–suicide ideation during the past year. The hierarchical logistic regression analysis showed that demographic factors including age, gender, and ethnicity had no significant effect. Family finances, depression, and conflict with the respondent's spouse were positively associated with filicide–suicide ideation. Finally, the parents’ beliefs in traditional family values had a positive effect on filicide–suicide ideation. In other words, filicide–suicide thoughts were more common among those who upheld a strong parental responsibility for care giving and family solidarity. This study revealed a substantial prevalence of filicide–suicide ideation among local parents and identified a number of risk factors associated with those thoughts, namely family financial status, parental depression, and conflict with one's spouse. More importantly, the results highlighted the effect of traditional family values in the process. The potential intention of filicide–suicide as mercy killing and its cultural relevance were discussed.     

A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment

Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR = 28.0 (95 CI 4.6–170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.     

负性生活事件潜在类别分析在大学生自杀风险筛查中的应用

This research collected 9295 university students’ stressful life events (SLEs) and suicide attempts within a year to conduct a latent class analysis and logical regression to explore the latent class and its correlation with the risk of suicide. The results showed that samples could be grouped in “less major SLEs”, “SLEs related to mental disorders” and “SLEs related to family atmosphere”, and students who experienced SLEs related to mental disorders and family atmosphere had higher risks of suicide, with those experiencing SLEs related to mental disorders to have the highest risks of suicide     

Crisis prevention and intervention: A survey of school psychologists

A random sample of 197 practicing school psychologists who were members of the National Association of School Psychologists (NASP) completed a survey questionnaire on experiences and perceptions with regard to school crisis preparedness, prevention, and intervention. Respondents indicated having the most direct experience with student–student physical assaults, serious illness or injury of students, unexpected students deaths, suicide attempts, and guns or other weapons at school. School psychologists reported that their schools used a wide variety of prevention and intervention strategies, most of which have been advocated in the literature. Respondents reported being most involved in the implementation of crisis prevention and intervention strategies and less involved in development and evaluation. Results and implications are discussed within the context of empirically supported practices and school psychologists' readiness to assume larger roles in crisis prevention and intervention. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 777–788, 2004.