Risk Factors for Medically Serious Suicide Attempts: Evidence for a Psychodynamic Formulation of Suicidal Crisis

James Chris Fowler, Mark J. Hilsenroth, Michael Groat, Spencer Biel, Christina Biedermann, Steven Ackerman

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

This study explored a psychodynamic model for suicide risk by examining risk factors for medically serious suicide attempts, including assessments of affect flooding, negative self-schema / fragmentation, and impaired reality testing, closely approximating Maltsberger's psycho-dynamic formulation of suicide crisis. Baseline risk factors including age, gender, psychiatric symptoms, high-risk behaviors, and the Implicit Risk for Suicide Index (IRSI) were used to detect medically serious suicide attempts monitored for up to a year after the assessment. Twenty-five psychiatric inpatients who made life-threatening suicide attempts after assessment were compared to 25 inpatients and 25 psychotherapy outpatients who made no suicide attempts during follow-up. Statistical analysis revealed that a history of at least one suicide attempt and elevated IRSI scores accounted for 60 percent of the variance in detecting medically serious suicide attempts. Elevated IRSI accurately identified suicide attempt status above and beyond past suicide attempts and other empirically validated risk factors. Results are discussed in light of psychodynamic formulations of suicide risk.

Original languageEnglish (US)
Pages (from-to)555-576
Number of pages22
JournalJournal of the American Psychoanalytic Association
Volume60
Issue number3
DOIs
StatePublished - Jun 2012

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Psychology

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