CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

A Prevention Glossary

Alcohol abuse: A maladaptive pattern of alcohol use that leads to clinically significant impairment or distress, as manifested by one or more of the following occurring within a 12-month period: recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home; recurrent alcohol use in physically hazardous situations, recurrent alcohol-related legal problems; continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. In the literature on economic costs, alcohol abuse means any cost-generating aspect of alcohol consumption; this definition differs from the clinical use of term, which involves specific diagnostic outcomes.

Alcohol dependence: A maladaptive pattern of alcohol use that leads to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period: tolerance; withdrawal; often taking alcohol in larger amounts or over a longer period than was intended; persistent desire or unsuccessful efforts to cut down or control alcohol use; spending a great deal of time in activities necessary to obtain alcohol or recover from its effects; giving up or reducing important social, occupational, or recreational activities because of alcohol use; continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

Anxiety disorders: Anxiety disorders have multiple physical and psychological symptoms, but all have in common feelings of apprehension, tension, or uneasiness. Among the anxiety disorders are panic disorder, agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder.

Best practices: activities or programs that are in keeping with the best available evidence regarding what is effective.

Binge drinking: The National Household Survey on Drug Abuse defines binge drinking as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. The Monitoring the Future Study defines binge drinking as drinking five or more drinks on the same occasion during the past 2 weeks.

Bipolar disorder: A mood disorder characterized by the presence of history of manic episodes, usually, but not necessarily, alternating with depressive episodes.

Community: A group of people residing in the same locality or sharing a common interest.

Comprehensive suicide prevention plans: Plans that use a multifaceted approach to addressing the problem, for example, including interventions targeting biopsychosocial, social, and environmental factors.

Contagion: A phenomenon whereby susceptible persons are influenced toward suicidal behaviors through knowledge of another person's suicidal acts.

Co-occurring disorders: The simultaneous presence of two or more disorders, such as the coexistence of a mental health disorder and substance abuse problem.

Culturally appropriate: A set of values, behaviors, attitudes, and practices reflected in the work of an organization or program that enables it to be effective across cultures; includes the ability of that program to honor and respect the beliefs, language, interpersonal styles, and behaviors of individuals and families receiving services.

Culture: The integrated pattern of human behavior that includes thoughts, communication, actions, customs, beliefs, values, and institutions of a racial, ethnic, faith or social group.

Depression: A state of low mood that is described differently by people who experience it. Commonly described are feelings of sadness, despair, emptiness, or loss of interest or pleasure in nearly all things. Depression also can be experienced in other disorders such as bipolar disorder (manic-depressive disorder).

Diagnosable mental illness: Includes all people with a mental illness in a specified population group, whether or not they have received a formal diagnosis from a medical or mental health professional.

Drug dependence: A pattern of drug use leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period: tolerance; withdrawal; use in larger amounts or over a longer period of time than intended; persistent desire or unsuccessful efforts to cut down; spending a great deal of time in activities necessary to obtain drug(s); giving up or reducing important social, occupational, or recreational activities; continued use despite knowledge of having a persistent or recurrent physical or psychological problem.

Effective: Prevention programs that have been scientifically evaluated and shown to decrease and adverse outcome or increase a beneficial one in the target group more than in a comparison group.

Environmental factors: The policies, systems, social contexts, and physical barriers or facilitators that affect a person's participation in activities, including work, school, leisure, and community events.

Evidence-based: Programs that have undergone scientific evaluations and have proven to be effective.

Gatekeepers: Those individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine; they may be trained to identify persons at risk of suicide and refer them to treatment or supporting services as appropriate.

Indicated preventive interventions: Interventions targeted to reach high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing substance abuse or biological or familial markers indicating predisposition for substance abuse, even though they do not meet DSM-III-R diagnostic levels at the current time.

Intervention: A strategy or approach that is intended to prevent an outcome or to alter the course of an existing condition (such as providing lithium for bipolar disorder or strengthening social support in a community).

Means: The instrument or object whereby a self-destructive act is carried out (i.e., firearm, poison, medication).

Means restriction: Techniques, policies, and procedures designed to reduce access or availability to means and methods of deliberate self-harm.

Mental health services: Diagnostic, treatment, and preventive care that helps improve how persons with mental illness feel both physically and emotionally as well as how they interact with other persons. These services also help persons who have a strong risk of developing a mental illness.

Mental illness: The term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions characterized by alterations in thinking, mood, or behavior (or some combination thereof) that are all mediated by the brain and associated with distress or impaired functioning or both. Mental disorders spawn a host of human problems that may include personal distress, impaired functioning and disability, pain, or death. These disorders can occur in men and women of any age and in all racial and ethnic groups. They can be the result of family history, genetics, or other biological, environmental, social, or behavioral factors that occur alone or in combination.

Methods: Actions or techniques which result in an individual inflicting self-harm (i.e., asphyxiation, overdose, jumping).

Mood disorders: A term used to describe all mental disorders that are characterized by a prominent or persistent mood disturbance; disturbances can be in the direction of elevated expansive emotional states, or, if in the opposite direction, depressed emotional states; included are Depressive Disorders, Bipolar Disorders, mood disorders due to a medical condition, and substance-induced mood disorders.

Parity, mental health parity: Equivalent benefits and restrictions in insurance coverage for mental health services and for other health services.

Patient barriers: Any mental, physical, or psychosocial condition that prevents an individual from accessing needed health care. Examples include attitudes or biases, mental disorders or illnesses, behavioral disorders, physical limitations, cultural or linguistic factors, sexual orientation, and financial constraints.

Protective factors: Factors that make it less likely that individuals will develop a disorder; protective factors may encompass biological, psychological or social factors in the individual, family, and environment.

Provider barriers: Any mental, physical, psychosocial, or environmental condition that prevents or discourages health care providers from offering preventive services. Examples of provider barriers include a poor practice environment, lack of knowledge, and lack of efficacy studies.

Resilience: Manifested competence in the context of significant challenges to adaptation or development.

Risk factors: Those factors that make it more likely that individuals will develop a disorder; risk factors may encompass biological, psychological, or social factors in the individual, family, and environment.

Schizophrenia: A mental disorder lasting for at least 6 months, including at least 1 month with two or more active-phase symptoms. Active-phase symptoms include delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Schizophrenia is accompanied by marked impairment in social or occupational functioning.

Screening for mental health problems: A brief formal or informal assessment to identify persons who have mental health problems or are likely to develop such problems. The screening process helps determine whether a person has a problem, and, if so, the most appropriate mental health services for that person.

Screening tools: Those instruments and techniques (questionnaires, check lists, self-assessment forms) used to evaluate individuals for increased risk of certain health problems.

Selective preventive interventions: Interventions targeted to individuals or a subgroup of the population whose risk of developing substance abuse is significantly higher than average. The risk may be imminent, or it may be a lifetime risk. The basis may be biological, psychological, or environmental.

Serious emotional disturbance (SED): A diagnosable mental disorder found in persons from birth to age 18 years that is so severe that long lasting that it seriously interferes with functioning in family, school, community, or other major life activities.

Serious mental illness (SMI): A diagnosable mental disorder found in persons aged 18 years and older that is so long lasting and severe that it seriously interferes with a person's ability to take part in major life activities.

Stigma: An object, idea, or label associated with disgrace or reproach.

Substance abuse: The problematic consumption or illicit use of alcoholic beverages, tobacco products, and drugs, including misuse of prescription drugs.

Suicidal act (also referred to as suicide attempt): A potentially self-injurious behavior for which there is evidence that the person probably intended to kill himself or herself; a suicidal act may result in death, injuries, or no injuries.

Suicidal behavior: A spectrum of activities related to thoughts and behaviors that include suicidal thinking, suicide attempts, and completed suicide.

Suicidal ideation: Self-reported thoughts of engaging in suicide-related behavior.

Suicidality: A term that encompasses suicidal thoughts, ideation, plans, suicide attempts, and completed suicide.

Suicide: Death from injury, poisoning, or suffocation where there is evidence that a self-inflicted act led to the person's death.

Suicide attempt: A potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person intended to kill himself or herself; a suicide attempt may or may not result in injuries.

Suicide attempt survivors: Individuals who have survived a prior suicide attempt.

Suicide survivors: Family members, significant others, or acquaintances who have experienced the loss of a loved one due to suicide; sometimes this term is also used to mean suicide attempt survivors.

System barriers: Conditions within a health care system that prevent people from accessing needed services or prevent health care providers from delivering those services. System barriers include physical, cultural, linguistic, and financial barriers as well as the availability of health care facilities or providers with special skills.

Universal preventive interventions: Interventions targeted to the public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Universal interventions have advantages in terms of cost and overall effectiveness for large populations.

Vulnerable and at-risk populations: High-risk groups of people who have multiple health and social needs. Examples include pregnant women, people with human immunodeficiency virus infection, substance abusers, migrant farm workers, homeless people, poor people, infants and children, elderly people, people with disabilities, people with mental illness or mental health problems or disorders, and people from certain ethnic or racial groups who do not have the same access to quality health care services as other populations.

Years of potential life lost (YPLL): A statistical measure used to determine premature death. YPLL is calculated by subtracting an individual's age at death from a predetermined life expectancy. The Centers for Disease Control and Prevention generally uses 75 years of age for this purpose (for example, a person who died at aged 35 years would have a YPLL of 40).

Unless otherwise noted, all definitions are reprinted from Healthy People 2010.

Reprinted from U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Mental Health Information Center, Center for Mental Health Services. (2001). National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: Author.