Columbia Suicide Severity Rating Scale (C-SSRS)

The Columbia Suicide Severity Rating Scale (C-SSRS) is often considered the gold standard of suicide risk assessment (Giddens, Sheehan & Sheehan, 2014). It was developed in 2011 by a team from Columbia University and has been validated with both adult and adolescent populations (Posner, et. al., 2011)

Items in the C-SSRS

The C-SSRS can be downloaded here. It has the following categories and questions. Suicidal Ideation and Behaviour are scored as yes/no, while Intensity of Ideation and Actual Attempts are scored by points.

Suicidal Ideation

  1. Wish to be dead
  2. Non-Specific Active Suicidal Thoughts
  3. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act
  4. Active Suicidal Ideation with Some Intent to Act, without Specific Plan
  5. Active Suicidal Ideation with Specific Plan and Intent

Intensity of Ideation

  • Frequency
  • Duration
  • Controllability
  • Deterrents
  • Reasons for Ideation

Suicidal Behaviour

  • Actual Attempt
  • Has subject engaged in Non-Suicidal Self-Injurious Behavior?
  • Aborted Attempt
  • Preparatory Acts or Behavior
  • Suicidal Behavior
  • Completed Suicide

Answer for Actual Attempts Only

  • Actual Lethality/Medical Damage
  • Potential Lethality: Only Answer if Actual Lethality=0

Scoring

There are different scoring systems depending on the population. The important elements to note are that the higher the scores on the individual items and the more “yes” items, the higher the suicide risk. The C-SSRS training noted below lists high risk as being “ideation, a four or five in the past month; or any of the four behaviors in the last three months.”

Additionally, linked here are some scoring systems that can be used in various environments (community agencies, military, hospital inpatients, etc.)

C-SSRS Training

There is full training available online through the C-SRSS website.

Bibliography

Giddens, J.M., Sheehan, K.H., Sheehan, D.V. (2014) “The Columbia–Suicide Severity Rating Scale (C–SSRS): Has the “Gold Standard” Become a Liability?” Innovations in Clinical Neuroscience. 11(9–10):66–80

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., & … Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults. American Journal Of Psychiatry, 168(12), 1256. doi:10.1176/appi.ajp.2011.10111704

Cite this article as: MacDonald, D.K., (2015), "Columbia Suicide Severity Rating Scale (C-SSRS)," retrieved on September 21, 2017 from http://dustinkmacdonald.com/columbia-suicide-severity-rating-scale-c-ssrs/.
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False Accusations of Sexual Violence

A common question asked by men and women is what percent of sexual assault accusations (almost always assumed to be by women against men) are false?

False accusations of sexual assault result in significant upheaval in an individual’s life. An individual who is accused of sexual assault may be terminated from their employment, removed from their school, and face impairment in their relationships. This is true whether they are found guilty or not. An additional complication is that newspapers often publish the names of accused individuals, regardless of their conviction. Rape shield laws usually prevent the publication of the accuser.

In the United States, enforcement of the provisions of Title IX have resulted in individuals removed from their universities without trial, which may be a violation of their due process and civil rights.

There is significant debate on the prevalence rates of false accusations which depend on the methodology of the studies consulted and the source.

Police Beliefs Regarding Sexual Assault

Jordan (2004) notes a 1980 study that found that police believed an average of 3 out of 5 rape accusations were false, and a 1997 study where at least half of the surveyed police believed 25% of rape accusations to be false. This reflected police belief that rapes are primarily conducted by strangers off the street, not by people who went out for the night with their rapist. Additional studies noted by Jordan have false rapes pegged police at 50-80%. It is clear that many police officers believe false rape accusations are common. These studies all seem to refer exclusively to male perpetrators and female victims.

Characteristics noted by Jordan as influencing police decisions to classify a case as false include:

  • Impaired (drugs or alcohol)
  • A delay in reporting the crime to police
  • Having previously had consensual sex with the accused
  • Having a previous rape or abuse
  • Mental health issues
  • Perceiving the accuser as immoral
  • An intellectual impairment
  • A previous false rape complaint
  • Concealing information important to the investigation

One factor noted that strongly influenced the rate of genuineness was the presence of physical injuries, which may not be present in many instances of sexual violence. Johnson, Griffith & Barnaby (2013) discuss the frequent error in suspect identification when the perpetrator is black and the victim is white and how this may influence false accusations.

Prevalence of False Accusations

Spohn, White & Tellis (2014), who examined police files of the LAPD and found a rate of 4.5%, while Lonsway, Archambault & Lisak (2009) found a rate of “between 2 and 8%” when studies with strong methodology have been taken into account. This last study notes the issues with police classifications that may result in the under-reporting of the rate of sexual violence.

Spohn, White & Tellis cite other studies in their literature review, which are reproduced here for reference:

  • Kelly (2010) found a rate of 3% – This study is discussed in the Opposing Narrative section.
  • Lisak (2010) found a rate of 6%

Spohn et. al. note methodological issues with both of these studies.

Opposing Narrative

Kelly (2010) states that rape is a gendered crime, “which creates conditions of virtual impunity for predatory men.” It also states there is a lack of services for women who are victim-survivors of sexual violence.

Kelly, Lovett & Regan (2005) notes that of the 8% of rape cases declared false in their first study, only 18% had a named suspect, and less than 3% involved an arrest. This contradicts the belief that many men are being arrested for false accusations.

In their second study, “rates of false allegations ranged between 1% and 9%, with the majority at 6% or less.” Kelly’s rate of 3% was determined by excluding cases where the suspect’s credibility was based on the issues identified by Jordan above.

O’Neal et. al. (2014) identify five categories that may result in false accusations:

  1. Avoiding trouble
  2. Providing an alibi
  3. Anger or revenge
  4. Attention seeking
  5. Mental illness
  6. Guilt or remorse.

They state that a more complex view of false accusations is necessary, to take into account the personal factors that may lead to a false accusation.

Potential Solutions

There are few solutions to the problem of false accusation as one cannot control an individual’s statements to police. Improving the coding standards of police to ensure that accusations dropped for lack of evidence or retracted because of a disinterest in the legal process are not automatically classified as false.

Additionally, cases where falsehoods have been proven, prosecution of that individual is necessary in order to deter future instances of false accusation. Edit Oct-20/2015: I’d like to clarify this statement. In cases where beyond a reasonable doubt (e.g. a confession or video taped exculpatory evidence) an accusation of sexual assault was made in bad faith, it is important that, as with all false police reports involving major crimes, the accuser is prosecuted. This should hold true regardless of gender of the perpetrator or victim.

Rewriting rape shields laws so as to protect the names of both the accused and the accuser would prevent false accusations from pre-emptively causing damage to the life of someone who has not been convicted yet.

Finally, removing the ability of campuses in the United States to remove individuals who have not been convicted (indeed, or even charged) of a crime may improve their adherence to due process and protection of individuals civil rights.

Limitations in the Literature

One area that has not, as far as I know, received any exploration in the literature is the prevalence of false accusations by men against women. Interestingly, while sexual assault is assumed to be primarily by male perpetrators against women victims/survivors, the assumption is reversed in false accusations (with nobody believing men would make false accusations of sexual violence against a woman.)

Bibliography

Johnson, M.B., Griffith, S., Barnaby, C.Y. (2013) African Americans Wrongly Convicted of Sexual Assault Against Whites: Eyewitness Error and Other Case Features. Journal of Ethnicity in Criminal Justice, 11:277–294. doi: 10.1080/15377938.2013.813285.

Jordan, J. (2004) Beyond belief? Police, rape and women’s credibility. Criminal Justice. 1466–8025; Vol: 4(1): 29–59. doi: 10.1177/1466802504042222

Kelly, L. (2010) “The (In)Credible Words of Women: False Allegations in European Rape Research,” 16 Violence Against Women 1345–55.

Lisak, D, Gardinier, L., S.C. Nicksa, & Cote, A.M. (2010) False Allegations of Sexual Assault: An Analysis of Ten Years of Reported Case. Violence Against Women 1318–34.

Lonsway, K.A., Archambault, J., & Lisak D. (2009) False Reports: Moving Beyond the Issue to Successfully Investigate and Prosecute Non-Stranger Sexual Assault. The Voice. 1–11.

O’Neal, E. N., Spohn, C., Tellis, K. & White, C. (2014) The Truth Behind the Lies: The Complex Motivations for False Allegations of Sexual Assault. Women & Criminal Justice, 24:324–340.

Spohn, C., White, C., Tellis, K. (2014) Unfounding Sexual Assault: Examining the Decision to Unfound and Identifying False Reports. Law & Society Review. (48)1.



Cite this article as: MacDonald, D.K., (2015), "False Accusations of Sexual Violence," retrieved on September 21, 2017 from http://dustinkmacdonald.com/false-accusations-of-sexual-violence/.

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Understanding and Preventing Male Suicide

Introduction

Suicide is a significant public health issue in most countries. Suicide rates have been constant in the US and Canada, with some age and risk categories experiencing reduced suicide rates while increased suicide rates in other age groups and risk categories have made up the difference.

Male suicide has been commonly overlooked as suicide has not been seen as a gendered issue. Unfortunately, as more men than women die in virtually every country where the World Health Organization publishes data (2012) there exist the potential for significant reductions to be made in the suicide rate by interventions targeted specifically at men.

Suicide Statistics: A Comparison

Suicide rates are presented here for Canada, broken down by age range and gender.

Age Range Male Female Total Male % of Total
10 to 14 12 17 29 41.38%
15 to 19 140 58 198 70.71%
20 to 24 224 77 301 74.42%
25 to 29 198 63 261 75.86%
30 to 34 212 71 283 74.91%
35 to 39 220 68 288 76.39%
40 to 44 267 87 354 75.42%
45 to 49 318 114 432 73.61%
50 to 54 322 121 443 72.69%
55 to 59 273 102 375 72.80%
60 to 64 186 59 245 75.92%
65 to 69 117 33 150 78.00%
70 to 74 107 21 128 83.59%
75 to 79 78 23 101 77.23%
80 to 84 60 16 76 78.95%
85 to 89 36 13 49 73.47%
90 and older 10 3 13 76.92%
Total 2780 946 3726

As you can see, male suicides make up the majority of suicides in every age range except the 10-14 rate, where girls outnumbered boys. That is certainly worthy of further research by child suicide prevention specialists.

In Canada, suicide rates peak for men around 45-54, which contrasts with other countries where suicide rates increase with age after 30 and suicide rates in the elderly are the fastest growing group.

Suicide Methods

The most common method of suicide in the United States is firearms, accounting for 51% of the suicides in the US (Barber & Miller, 2014), followed by suffocation/hanging (25%), overdose/poisoning (17%) and other methods at 7.6%. (Centers for Disease Control and Prevention, 2013)

Because 85% of firearm suicide attempts result in death while only 2% of overdoses do (Vyrostek,  Annest, & Ryan, 2004), and because men most often choose methods like firearm and hanging over overdosing (Callanan & Davis, 2012), reducing access to firearms can significantly reduce the amount of male suicide.

Theories of Suicidal Behaviour

There are a number of theories that attempt to explain suicidal behaviour. These include the Interpersonal Theory of Suicide, the Stress-Diathesis Model, and the Integrated Motivational-Volitional Model. The interpersonal theory is detailed below.

The Interpersonal Theory of Suicide suggests that you need three elements for suicide to take place:

  • Thwarted Belongingness
  • Perceived Burdensomeness
  • Acquired Suicide Capability

Thwarted belongingness involves feeling like you have no social support or that you do not belong in your peer group. This can also be called “alienation.” Men are known to have smaller social circles (McPherson, Smith-Lovin & Brashears, 2006) and fewer access to social support when they are distressed.

Perceived burdensomeness refers to the idea that you feel like a burden on those around you. For men, this can present as being unable to be a provider or support their family.

Finally, acquired suicide capability refers to events that give you the capability to die by suicide. This includes exposure to war, physical abuse, fighting, self-injurious behaviour (cutting, etc.), or other elements that desensitize you to painful or fear-inducing experiences.

Men are more likely than women to be victims and perpetrators of violence (Statistics Canada, 2006), they make up the majority of occupational injuries (Bureau of Labour Statistics, 2013) and sufferers of substance abuse (Cotto, 2010). All of these items can increase men’s suicidality.

Additionally, suicidal intent (desire to die) has been associated with use of more lethal suicide methods. What this means is that although women attempt suicide at a rate of 3x men do, they don’t intend to die. The goal of attempting suicide is to accomplish other means. Update Nov-1/15 This is in fact incorrect and there is research support to the idea that women have similar levels of suicide intent as men (Denning, Conwell, King & Cox, 2000).

Player et. al. (2015) suggest that male coping strategies are responsible. While women increase their social support and look outward when they are feeling suicidal, men often wall themselves off from others to avoid being a burden. This only amplifies their systems and increases their distress, which can prevent an interruption in the suicidal process that may happen with women.

Clinical Interventions to Reduce Male Suicide

Interventions for suicide that can help individual men include:

Counseling on Access to Lethal Means. By reducing access to lethal means like firearms you can reduce an individual’s chance of dying by suicide. Many suicide attempts are made impulsively and having a gun makes a suicide attempt much more lethal.

Treatment for substance abuse.  Many suicides involve drugs and alcohol and so getting off drugs and alcohol can reduce a person’s reason and ability to attempt suicide, both because of the impact of substance abuse on a person’s ability to function in their day-to-day life (especially as it relates to relationships) but also because drugs and alcohol can make people — young men especially — more impulsive.

Increasing social circles. The average man has a social circle smaller than women. This lack of close friends means that men are not able to express themselves emotionally.

Self-esteem training. This can be a part of counselling or therapy or an initiative on it’s own. Group environments in particular provide an opportunity to both build a man’s social skills and his self-esteem. The benefit of high self esteem is that it can reduce a man’s perception that he is a burden, one of the key elements for suicide.

Public Health Strategies to Reduce Male Suicide

From a public health perspective, there are a few interventions we can help reduce male suicide.

Getting more men in front of family doctors. Men have poor records of going to the doctor when they need to, or even for regular checkups. Because physical health issues can prevent men from working or otherwise providing for themselves (creating the feeling of burdensomeness), physical health care is an important element to reducing suicidal ideation.

Screening for suicide and substance abuse by family doctors. Once men are in front of their physician, it’s important that they’re able to recognize the signs and symptoms of suicidal ideation and substance abuse. It has been noted that mental health professionals are less likely to diagnose depression in men and this is also an area for exploration.

Improved services for sexual violence. With as many as 1 in 6 men experiencing sexual abuse/assault in their lifetime (Dube, Anda & Whitfield, 2005) and a lack of services like rape crisis centres that provide service to men, suicide as a result of the after-effects of abuse will continue to be a devastating issue.

Areas for Additional Research

Areas for additional research include whether men respond differently to standard treatments for depression or substance abuse, or if there are any ways to intervene with men experiencing suicidal ideation that are particularly effective.

Bibliography

Barber, C.W., Miller, M.J. (2014) Reducing a Suicidal Person’s Access to Lethal Means of Suicide: A Research Agenda. American Journal of Preventive Medicine. 47(3S2):S264–S272

Centers for Disease Control and Prevention. (2013) Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed Jun 21 2015 from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html

Denning, D.G., Conwell, Y., King, D., Cox, C. (2000) Method choice, intent, and gender in completed suicide. Journal of Suicide and Life Threatening Behaviour. 30(3). 282-288

Dube, S.R., Anda, R.F. & Whitfield, C.L., et al. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28, 430-438.

Callanan, V.J., Davis, M.S. Gender differences in suicide methods. (2012). Social Psychiatry and Psychiatric Epidemiology. 47:857–869 DOI 10.1007/s00127-011-0393-5

Cotto, J.H. et al. (2010) Gender effects on drug use, abuse, and dependence: An analysis of results from the National Survey on Drug Use and Health. Gender Medicine. 7(5):402-413

“Fatal occupational injuries in 2013.” Bureau of Labour Statistics. (2013). Accessed from http://www.bls.gov/iif/oshwc/cfoi/cfch0012.pdf on Sep 5 2015.

Global Health Observatory Data Repository. (2012) World Health Organization. Accessed from http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en on Sep 1 2015.

McPherson, M., Smith-Lovin, L., Brashears, M.E. (2006) Social Isolation in America: Changes in Core Discussion Networks Over Two Decades. American Sociological Review. 71(3).

Player MJ, Proudfoot J, Fogarty A, Whittle E, Spurrier M, Shand F, et al. (2015) What Interrupts Suicide Attempts in Men: A Qualitative Study. PLoS ONE 10(6): e0128180. doi:10.1371/journal.pone.0128180

Vaillancourt, R. 2010. Gender differences in police-reported violent crime in Canada, 2008. Catalogue no. 85F0033M, no. 24. Ottawa: Statistics Canada.

Vyrostek S.B., Annest, J.L, & Ryan, G.W. Surveillance for fatal and nonfatal injuries–United States, 2001. Morbidity and Mortality Weekly Report. 2004:53(SS07);1-57.

Cite this article as: MacDonald, D.K., (2015), "Understanding and Preventing Male Suicide," retrieved on September 21, 2017 from http://dustinkmacdonald.com/understanding-and-preventing-male-suicide/.
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