According to the United States Centers for Disease Control and Prevention (CDC), an average of 105 people died each day by suicide in the United States in 2010, a total of 38,364. Over 487,700 people with self-inflicted injuries were treated in United States emergency departments in 2011. It is believed that these numbers underestimate the problem. Many people who have suicidal thoughts or make suicide attempts never seek services.
As the most lethal psychiatric problem faced by today’s mental health professionals, it is incumbent upon each practitioner to maintain a thorough and current working knowledge of professional best practices regarding suicide assessment and prevention, as well as a thorough understanding of the ethical and legal implications of assessment and treatment services in the jurisdictions in which they work.
Resources publically available include the following:
“Understanding Suicide.” Centers for Disease Control. http://www.cdc.gov/ViolencePrevention/pdf/Suicide_FactSheet_2012-a.pdf
“Suicide Prevention.” National Institute of Mental Health.
“National Strategy for Suicide Prevention.” Action Alliance for Suicide Prevention.
“National Strategy for Suicide Prevention: Goals and Objectives for Action.” United States Department of Health and Human Services (Office of the Surgeon General).
Practitioners of logotherapy and existential analysis, the comprehensive psychological theory and therapy of Viktor Frankl, often have a special interest in this topic. Perhaps this is so because Frankl himself often treated suicidal patients. Between 1928 and 1930, Frankl organized a special program to counsel high school students free of charge. The first such youth counseling center was established in Vienna and the program then spread to six other cities. The program paid special attention to students at the time when they received their report cards. In 1931, for the first time in many years, not a single Viennese student committed suicide. Later, from 1933 to 1937, Frankl completed his residency in neurology and psychiatry at the Steinhof Psychiatric Hospital in Vienna. There, he was responsible for the women’s suicide pavilion where he treated about 3,000 female patients each year that had suicidal tendencies.
See Frankl, Viktor (2000). Recollections: An Autobiography. Cambridge, MA: Basic Books, p. 68 ff, 73 ff. For a convenient and easily accessible summary, see also “Viktor Frankl.” (n.d.). In Wikipedia. Retrieved April 19, 2014.
Current research findings of relevance to logotherapy and existential analysis provide support for the assertion that an inverse correlation exists between measures of reasons for living, or purpose in life, and suicidality. References that most clearly support this finding are given below. The “B&G” number refers to the abstract number as published in:
Batthyány, Alexander and Guttmann, David in collaboration with PsychINFO. (2006). Empirical Research on Logotherapy and Meaning-oriented Psychotherapy: An Annotated Bibliography. Phoenix: Zeig, Tucker & Theisen.
Dyck, Murray J. (1991). Positive and negative attitudes mediating suicide ideation. Suicide and Life-Threatening Behavior, 21, 360-373.
Suicide intent is related to both positive and negative attitudes (hopelessness and reasons for living) and these are both associated with personality dimensions.
Ellis, Jon B. and Smith, Peggy C. (1991). Spiritual well-being, social desirability and reasons for living: Is there a connection? International Journal of Social Psychiatry, 37, 57-63.
Demonstrates a strong relationship between reasons for not considering suicide and existential beliefs.
Harlow, Lisa L., Newcomb, Michael D., and Bentler, P.M. (1986). Depression, self-derogation, substance use, and suicide ideation: Lack of purpose in life as a meditational factor. Journal of Clinical Psychology, 42, 5-21.
Supports a theoretical model that depression and self-derogation among adolescents may lead to lack of purpose in life that then may lead to suicide and substance use.
Heisel, Marnin J. and Flett, Gordon L. (2004). Purpose in Life, satisfaction with life, and suicide ideation in a clinical sample. Journal of Psychopathology and Behavioral Assessment, 26, 127-135.
Demonstrates the potential value of attending to both resilience and pathology when building predictive models of suicide ideation and demonstrates the value of attending to key existential themes during assessment and treatment of suicidal individuals.
Kinkel, R. John, Bailey, Charles W., and Josef, Norma C. (1989). Correlates of adolescent suicide attempts: Alienation, drugs and social background. Journal of Alcohol and Drug Education, 34, 85-96.
Extreme pessimism and failure to find meaning in life proved to be important factors in identifying subjects at risk for suicide.
Kirkpatrick-Smith, Joyce, et. al. (1991-1992). Psychological vulnerability and substance abuse as predictors of suicide among adolescents. Omega: Journal of Death and Dying, 24, 21-33.
Four variables emerged as predictors of suicidal ideation: depression, hopelessness, few reasons for living, and substance use.
Lester, David and Badro, Souhel. (1992). Depression, suicidal preoccupation and purpose in life as a subclinical population. Personality and Individual Differences, 13, 75-76.
Scores from the Purpose in Life Test predicted current and previous suicidal preoccupation.
Malone, Kevin M., et. al. (2000). Protective factors against suicidal acts in major depression: Reasons for living. American Journal of Psychiatry, 157, 1084-1088.
Reasons for living correlated inversely with indicators of suicidality. Results suggest the subjective perception of stressful life events may be more germane to suicidal expression than their objective quality.
Miller, Jill S., Segal, Daniel L., and Coolidge, Frederick, L. (2002). Rural-urban differences in reasons for living. Australian and New Zealand Journal of Psychiatry, 36, 688-692.
Rural residents reported having significantly more to live for than their urban counterparts. This contrasts with the increase in the rural suicide rate noted in Australia, highlighting the need for a greater understanding of suicidal behavior.
Moore, Sharon L. (1997). A phenomenological study of meaning in life in suicidal older adults. Archives of Psychiatric Nursing, 11, 29-36.
Interviews with suicidal older adults revealed key themes of alienation, broken connections, and meaninglessness.
Neyra, Carmen J., Range, Lillian M., and Goggin, William C. (1990). Reasons for living following success and failure in suicidal and non-suicidal college students. Journal of Applied Social Psychology, 20, 861-868.
Non-suicidal students were shown to have significantly higher scores on a measure of reasons for living than their suicidal peers.
Orbach, Israel, et. al. (2003). Mental pain and its relationship to suicidality and life meaning. Suicide and Life-Threatening Behavior, 33, 231-241.
Demonstrated that a measure of mental pain is related to suicide and demonstrated that loss of life’s meaning is related to mental pain. According to the authors, this study specifically set out to demonstrate Frankl’s hypothesis that loss of meaning in life is related to mental pain.
Pinto, Aureen, Whisman, Mark A., and Conwell, Yeates. (1998). Reasons for living in a clinical sample of adolescents. Journal of Adolescence, 21, 397-405,
Supports a measure of reasons for living as sound for clinical and research assessment in adolescents.
Range, Lillian M., Hall, Derek, L., and Meyers. (1993). Factor structure of adolescents’ scores on the Reasons for Living Inventory. Death Studies, 17, 257-266.
Suggests that a low score on this measure should be taken as particularly troublesome.
Range, Lillian M. and Penton, Susan R. (1994). Hope, hopelessness, and suicidality in college students. Psychological Reports, 75, Spec Issue 456-458.
Supports the validity of a measure of hope compared against a measure of reasons for living.
Rich, Alexander R. and Bonner, Ronald L. (1987). Concurrent validity of a stress-vulnerability model of suicidal ideation and behavior: A follow-up study. Suicide and Life-Threatening Behavior, 17, 265-270.
Multiple regression analysis indicated that 30% of the variation in suicide ideation scores could be accounted for by a linear combination of negative life stress, depression, loneliness, and few reasons for living.
Strosahl, Kirk, Chiles, John A., and Linehan, Marsha. (1992). Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Comprehensive Psychiatry, 33, 366-373.
A measure of survival and coping beliefs emerged as the single most important predictor of suicide intent.
Westefeld, John S., et. al. (1996). The College Student Reasons for Living Inventory: Additional psychometric data. Journal of College Student Development, 37, 348-350.
Found that this measure of reasons for living holds promise as an instrument to predict suicidal risk in college students.
Cole, David A. (1989). Validation of the Reasons for Living Inventory in general and delinquent adolescent samples. Journal of Abnormal Child Psychology, 17, 13-27.
Evidence of construct validity emerged in that the subscales of this measure related to suicidal thoughts and behaviors over and above depression and hopelessness.