Positive Parenting

Suicide Risk

Pic 0: The title card appears before transitioning to Dr. Eber and Austin sitting at the table.

Austin: After all we’ve talked about, we’ve decided as a primary care team to implement depression and substance use screenings for all our clients. They fill them out in the waiting room, and then we can evaluate the results before speaking with them.

Dr. Eber: That’s great. So, who’s your next client? 

Pic 1: The camera transitions to a close-up of Austin. A text box appears next to him with the title “Judith” with an image of a woman next to it. Underneath is a list:

Austin: Her name is Judith. She’s been our client for a fewyears. She has osteoarthritis, so she was prescribed Ibuprofen and physical therapy, but she's been back to our office a few times this year because of the pain.

Pic 2: The screen changes to a close-up of Dr. Eber.

Dr. Eber: Before you speak with Judith, let’s look at her screening results.

Judith’s responses to the substance-use screener suggested that she’s most likely not engaging in risky substance use.

Pic 3: The screen transitions to an image of a filled-in Patient Health Questionnaire (PHQ-2) which has 2 (More than half the days) circled in response to both “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless.” 

But her score of four on the PHQ-2 indicated that she needed to be screened further for depression, so we had her take the PHQ-9. Let’s take a look at the results.

Pic 4: The slide changes to an image of a filled-in Patient Health Questionnaire 2 (PHQ-9). The results are as follows:

  1. Little interest or pleasure in doing things: scale of 0 to 3, a 2 is marked.
  2. Feeling down, depressed, or hopeless: scale of 0 to 3, a 2 is marked.
  3. Trouble falling asleep, staying asleep, or sleeping too much: scale of 0 to 3, a 3 is marked.
  4. Feeling too tired or having little energy: scale of 0 to 3, a 3 is marked.
  5. Poor appetite or overeating: scale of 0 to 3, nothing is marked.
  6. Feeling bad about yourself or that you’re a failure or have let yourself or your family down: scale of 0 to 3, a 3 is marked.
  7. Trouble concentrating on things, such as reading the newspaper or watching television: scale of 0 to 3, a 1 is marked.
  8. Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety and restless that you have been moving around a lot more than usual: scale of 0 to 3, a 1 is marked.
  9. Thoughts that you would be better off dead or of hurting yourself in some way.

At the bottom, the column totals (3, 4, and 12) are added together, which is 19. A word bubble next to the score reads “Moderately severe depression.”

Below this is a tenth question which reads “If you checked off any problems, how difficult have those problems made it for you to do your work, take care of things at home, or get along with people?” Judith has marked it “Somewhat difficult.”

Judith says she’s had trouble sleeping, little energy, and abnormal eating habits nearly every day over the last two weeks and has experienced decreased interest in doing things and hopeless feelings on more than half the days. She also reports that she’s had thoughts that she would be better off dead or of hurting herself on several days.

Judith scored a 19, which correlates to moderately severe depression.

Pic 5: The screen returns to Dr. Eber and Austin at the table.

We need to talk to her about this, and we definitely need to follow up about question nine, where she indicates the possibility of suicidal thoughts.

Austin: What’s the best way to talk with a client about suicide? 

Pic 6: The camera moves to a close-up of Dr. Eber.

Dr. Eber: Some providers have the misconception that asking a client about suicide will plant the idea in the client’s head. This is not the case.

Pic 7: A text box appears next to Dr. Eber that reads “Asking about suicide does not increase tendencies,” with ‘does not’ highlighted in orange.

Asking about suicide does not increase suicidal tendencies, and clients who are at-risk for suicide often welcome an opportunity to talk to someone about what they’re going through.

Pic 8: The text box is replaced by a new one that reads “Sometimes people may feel like they don’t want to live anymore or think about killing themselves. Have you had any thoughts like these?”

The key is to be direct. You can say something like, “Sometimes people may feel like they don’t want to live anymore or think about killing themselves. Have you had any thoughts like these?”

Pic 9: The text box is replaced with a new one that’s divided in two. The top text reads “If ‘yes’ ask about plans and means.” The bottom text reads “If ‘no’ ask what has prevented harm.”

If the client answers “yes,” ask if she has a plan and the means to carry out that plan.

If the client answers “no,” ask what has prevented her from harming herself so far. This will help you determine how immediate the client’s risk might be. 

Pic 10: The screen changes to a slide titled “Suicide Risk Factors” which has a caution symbol next to it. It has the following list: