Alan L. Berman

Life stress and symptomatology: determinants of suicidal behavior in children.

Seventy-six children, aged 5 to 14, consecutively discharged from an inpatient psychiatric unit, were assigned by stringent operational criteria to either suicidal, depressed, or psychiatric control groups. Through a review of medical records, children were compared on measures of life stress and symptomatology for their total lifespan, for four defined developmental periods, and for the year preceding admission. Compared to both depressed and psychiatric control children, suicidal children experienced increasing and significantly greater amounts of stress as they matured, including a number of specific chaotic and disruptive family events which resulted in losses and separations from important people. Journal of the American Academy of Child Psychiatry , 21, 2:178–186, 1982.

Estimating the Population of Survivors of Suicide: Seeking an Evidence Base.

Shneidman (1973) derived an estimate of six survivors for every suicide that, in the ensuing years, has become an assumed fact underlying public health messaging campaigns in support of suicide prevention and postvention programs worldwide, in spite of it lacking either empirical testing or validation. This report offers a first test designed to derive estimates of suicide survivors and raises an array of empirical questions needing further study to reasonably address the impact of suicide on others.

Empirical criteria for the determination of suicide manner of death

A 16-item instrument was constructed as a tool to assist medicolegal official in their investigations and certifications of suicidal deaths. The Empirical Criteria for the Determination of Suicide (ECDS)--derived from a combined set of the 22 criterion items of the Operational Criteria for the Determination of Suicide (OCDS) and 33 other items obtained from experts and the professional literature--was constructed and validated by using 126 suicide and accident cases obtained from 70 medical examiner participants. Analysis of the cases confirmed that suicide is a manner of death in which there is evidence of both self-infliction and intention to die. The 16 items retained in the ECDS discriminated suicides from accidents best in relation to self-infliction and intention. In analysis of its concurrent validity, the ECDS instrument predicted 100% of the suicides and 83% of the accidents, thus correctly identifying 92% of all cases.

Group Psychotherapy Training. Issues and Models.

Picture, if you will, the proverbial black box. Enter an input of one graduate student: psychology type. Flick the switch marked &dquo;training: group psychotherapy&dquo;; allow the box to sputter and chug for some period of time until an output exits; and label this transformation &dquo;group psychotherapist.&dquo; &dquo;Capricious,&dquo; you say. You may even argue: &dquo;We discarded the black box as a sign of our professional maturity years ago.&dquo; Yet a review of the current state of the art of training in group psychotherapy raises a variety of unresolved, and often unattended, issues which plague our attempts to bring academic-based training in group psychotherapy out of its adolescence. Luckily, perhaps, the problems in effecting a workable training program in group psychotherapy are not indigenous to psychology. More applicably, the question being raised here is whether any of the mental health professions can train adequately a group

Belief in Afterlife, Religion, Religiosity and Life-Threatening Experiences:

The interrelated effects of religion, religiosity, belief in afterlife, and life-threatening experiences were studied to empirically test a number of previously untested propositions raised in the literature. The experience of a prior, subjectively perceived, inevitable death-threat had no effect on subsequent beliefs in a life after death (BA). On the other hand, BA was found to be primarily related to an ordered interaction among religions and religious activity. While religious activity appears not to serve to defend against an initially experienced stress reaction, the recall and report of life-threatening experiences over time occurs less frequently among religious versus non-religious Ss.

Epidemiological and follow-back study of suicides in Alaska.

Abstract Objectives. To conduct an in-depth analysis of all suicides occurring in Alaska between September 1, 2003 and August 31, 2006, and to conduct follow-back interviews with key informants for select cases. Study design. Suicide data were gathered from the Alaska Bureau of Vital Statistics, law enforcement agencies and the Alaska medical examiner’s office. Trained counsellors administered the 302 branching-question follow-back protocol during in-person interviews with key informants about the decedents. Methods. Suicide death certificates, medical examiner’s reports and police files were analysed retrospectively. Key informants were contacted for confidential interviews about the decedents’ life, especially regarding risk and protective factors. Results. There were 426 suicides during the 36-month study period. The suicide rate was 21.4/100,000. Males out-numbered females 4 to 1. The age-group of 20 to 29 had both the greatest number of suicides and the highest rate per 100,000 population. Alaska Natives had a suicide rate that was three times higher than the non-Native population. Follow-back interviews were conducted with 71 informants for 56 of the suicide decedents. Conclusions. This research adds significant information to our existing knowledge of suicide in Alaska, particularly as it affects the younger age groups among the Alaska Native population and the role of alcohol/drugs.

Training for Suicide Risk Assessment and Suicide Risk Formulation

Suicide and suicidal behaviors are highly associated with psychiatric disorders. Psychiatrists have significant opportunities to identify at-risk individuals and offer treatment to reduce that risk. Although a suicide risk assessment (SRA) is a core competency requirement, many lack the requisite training and skills to appropriately assess for suicide risk. Moreover, the standard of care requires psychiatrists to foresee the possibility that a patient might engage in suicidal behavior, hence to conduct a suicide risk formulation (SRF) sufficient to guide triage and treatment planning. An SRA gathers data about observable and reported symptoms, behaviors, and historical factors that are associated with suicide risk and protection, ascertained by way of psychiatric interview; collateral information from family, friends, and medical records; and psychometric scales and/or screening tools. Based on data collected via an SRA, an SRF is a process whereby the psychiatrist forms a judgment about a patient’s foreseeable risk of suicidal behavior in order to inform triage decisions, safety and treatment plans, and interventions to reduce risk. This paper addresses the need for a revised training model in SRA and SRF, and proposes a model of training that incorporates the acquisition of skills, relying heavily on case application exercises.

Late adulthood suicide: A life-span analysis of suicide notes

Older adults are the developmental age group across the lifespan at highest risk for suicide in many Western countries. Given the extent of the problem, the paucity of integrated and sound empirical research in this area is remarkable. Often the literature attributes the death to one or two variables (e.g., illness). However, a lifespan developmental approach calls for conceptualizing suicide in late adulthood from a multivariate perspective. This paper outlines two studies that were designed to investigate the suicide notes of the elderly in an adult lifespan perspective. The main conclusion is in support of a multivariate approach. There are more similarities than differences in suicide behaviour across the adult lifespan, although some differences were noted. The differences in the elderly appear to be issues of the inability to cope with the vicissitudes of aging (e.g., illness, isolation). It is concluded that future research is warranted.

Social Schemas: An Investigation of Age and Socialization Variables

The Felt Figure Replacement Technique (FFRT) was administered to 160 normally adjusted male Ss in three distinct chronological age groups. It was hypothesized that the existence of common social schemas would vary with age and that a neutral-latency group of Ss (aged 9.5 to 10.5 yr.) would produce different schematic reconstructions based on relative degrees of perceived maternal warmth. Chi-square analyses did not support the hypotheses. The results were interpreted as consistent with studies of perceptual accuracy and at odds with the use of the FFRT by groups of normal children. Contrasts were made with the positive findings of other researchers using deviant and/or mature normal Ss.

Treatment of the suicidal adolescent

Abstract An overview of the clinical assessment, treatment, and management of suicidal adolescents is presented. Risk assessment is discussed as a multifocal evaluation of variables related to negative personal history, psychopathology, the breakdown of defenses, social isolation, negative views of the self/hopelessness, and stress. Treatment planning is presented as addressing suicide lethality and intentionality through the selection of an appropriate site and modality of treatment (e.g., inpatient us. outpatient setting and individual us. family therapy). Individual psychotherapy is highlighted, with techniques of strategic crisis intervention and postcrisis intervention reviewed. Termination issues, malpractice liability concerns, and general principles of competent practice pertaining to clinical work with suicidal adolescents are also examined.