Review of the Applied Suicide Intervention Skills Training Program ...

disorder is generally a necessary but insufficient condition for suicide. To identify suicide risk factors, it
is necessary to look beyond the presence of a major psychiatric syndrome” (Mann, Waternaux, Haas, &
Malone, 1999, p. 181).
Individual factors that may contribute to suicide risk include:
• Biological Factors, including family risk, brain chemistry, gender, physiological problems
• Predisposing Factors, including psychiatric disorders, substance abuse, personality profile, severe
illnesses
• Proximal Factors, including hopelessness, intoxication, impulsiveness, aggressiveness, severe/
chronic pain
• Immediate Triggers, including public humiliation, access to weapons, severe defeat, major loss,
worsening prognosis (Knesper, n.d.)
A variety of sociocultural factors may also contribute to suicide risk. These include race, ethnicity, religion,
occupation, geography, and economic conditions, among others (Goldsmith, et al., 2002).
David Knesper of the University of Michigan’s Depression Center illustrated the complexity of suicide when
he stated that “Every suicide is a different story; every suicide is unique” (Knesper, n.d.)
1.3 Preventing suicide can be difficult
Because “every suicide is a different story”, the prevention of suicide can be difficult: what may be
effective in preventing one suicide may not be effective in preventing another. A recent review of suicide
prevention strategies found that only means restriction and physician education in the recognition and
treatment of depression gave evidence of reducing suicide deaths (Mann, Apter, Bertolote, & Beautrais,
2005). However, these approaches may be limited.
Restricting access to poisons, firearms, and certain high places has proven effective in decreasing suicide
deaths, but the application of this strategy may be limited by geography and cultural norms. Models of
professional education and their impact upon models of care may also be limited.
Standard models of care may be limited when addressing suicide risk
While standard care by a mental health professional or other professional caregiver represents a common
approach to addressing suicide risk in individuals, the effectiveness of this model may be limited by difficulties
in identifying those at risk, the availability of suicide-specific training, and poor compliance with care.
• Identifying those at risk of suicide is difficult. Since suicide is a behavior, not a disease, it
cannot be identified and assessed in the same way as physical maladies, such as heart disease and
cancer (Maris, Silverman, & Canetto, 1997). This makes the identification of those at risk for suicide
difficult (Maris, et al., 1997).
Trained professionals are not always available
• . While there is increasing evidence regarding
the efficacy of several psychotherapies can reduce suicide risk (McKeon, 2009), and training primary
care physicians to recognize and treat depression has demonstrated reductions in suicide deaths
(Rihmer, Rutz, & Pihlgren, 1995), there remains a lack of suicide-specific training for mental health
care professionals (Berman, et al., 2006).
6 Review of the Applied Suicide Intervention Skills Training Program (ASIST) LivingWorks Education