|
Affiliation
|
School of Social Sciences, Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, 4556, QLD, Australia. Electronic address: hstallman@usc.edu.au. |
|
Abstract
|
It is concerning that in 2019 suicide risk factors are still being investigated. The risk paradigm has been shown to be ineffective for identifying people likely to die by suicide and at reducing the prevalence of suicide.3
The reasons for this are clear. First, individuals are more than a set of risk and protective factors and both distress and coping are influenced by a complex interaction of biological, psychological, and social factors over the lifespan. Second, suicide is a relatively low bar as an outcome measure—quality of life is a patient-centred outcome and reduces the likelihood of habitual suicidal ideation leading to suicide. Third, there is no evidence to support the suggestion from Geulayov and colleagues that follow-up alone or brief interventions are sufficient for people presenting to hospital departments with overwhelming distress either before or after self-harm or suicide attempts. Fourth, suicidality does not sit within a vacuum—it is on a continuum of healthy and unhealthy coping strategies. Finally, correlational data, such as that reported by Geulayov and colleagues, are not causal data that can inform treatment.
Suicide results from overwhelming psychological distress. Some people die by suicide without any contact with health-care providers; therefore, the focus has been on prevention strategies, such as the ask for help message. However, as highlighted by Geulayov and colleagues, many people present with either distress after using unhealthy coping strategies (such as alcohol and drugs, and self-harm) or suicidality, or both. Health-care providers who interact with these patients have the potential to support them to reduce that overwhelming distress and save a life. Failure to provide effective treatment can have catastrophic consequences for patients, including death by suicide.
Effective suicide prevention at the individual presentation level comprises three steps. The first is to reduce the immediate distress by supporting the patient using a person-centred framework, for example, the Care · Collaborate · Connect model.
After a patient is calm and relaxed, which might take time, the second step is a systematic and comprehensive biopsychosocial assessment to understand the primary drivers of distress. The biopsychosocial components of health and wellbeing are healthy environments (eg, housing, finances, domestic violence, and other social and cultural problems), responsive parenting (ie, assessment of deficits in parenting regarding identity formation, emotional and behavioural regulation, interpersonal skills, and problem solving), sense of belonging, healthy behaviours (ie, sleep, nutrition, and exercise), coping strategies (both healthy and unhealthy), resilience (the strengths of bouncing back previously), and illnesses (physical and psychological). The third step in suicide prevention is to link the patient with adequate support and interventions to minimise the reoccurrence of overwhelming distress and reduce the likelihood of suicide by attending to the underlying biopsychosocial drivers of distress ...
Language: en |