Citation

Berman AL, Silverman MM. Crisis 2023; 44(3): 183-188.

Copyright

(Copyright © 2023, International Association for Suicide Prevention, Publisher Hogrefe Publishing)

DOI

10.1027/0227-5910/a000912

PMID

37265407

Abstract

First and foremost, we applaud Dr. Cohen and her colleagues for developing the suicide crisis syndrome (SCS) and its attendant focus on high and acute suicide risk, in particular that of high and acute suicide risk that is not dependent upon the patient's communicated suicide ideation (SI) as a gateway to its assessment. In several published papers (Berman & Silverman, 2014; Silverman & Berman, 2014a, 2014b) we have observed and commented upon the inadequacy of communicated or reported SI as a necessary condition to further establishing a patient's acute risk of suicide and lamented that clinicians too often assume that the absence of SI indicates the relative absence of suicide risk. There are now more than a dozen published studies of individuals who died by suicide who denied that they were thinking about suicide when they were last asked by a clinical caregiver often within days of their deaths (see Berman, 2018). These studies highlight the importance of symptomatic and behavioral signs of high and acute risk, rather than a dependence on communicated SI as a beacon of such risk.

Further, as we have written elsewhere (Silverman & Berman, 2020), we applaud Dr. Cohen and her colleagues for proposing the SCS with intent to make the features of a current crisis a central concern for the assessment and treatment of individuals at heightened risk. Suicide risk assessment is essential to make clinical care decisions and the SCS incorporates much of evidence-informed criteria to alert clinicians to patients needing intensive clinical care. However, proposing the SCS as a diagnosis is neither necessary nor sufficient for the purposes of improving the assessment and management of the person at such heightened risk (Wortzel et al., 2018).

Traditional suicide risk factors have only limited clinical predictive value (Franklin et al., 2017; Ribeiro et al., 2016), because they provide little reliable information on the acute psychological processes leading to suicide and on "imminent suicide risk" assessment (Voros et al., 2021). The individual criteria in the proposed SCS significantly focus our attention to cognitive, emotional, and behavioral signs of high and acute risk of suicidal behavior. It is these individual symptoms and behaviors that demand clinical attention and care decisions in order to mitigate that risk. In this regard, there is simply no need to create a suicide-specific diagnosis to identify targets for intervention, such as establishing and implementing treatment plans to counteract feelings of entrapment and manage behaviors indicative of hyperarousal...

Language: en