Youth Suicide Prevention with Kiwanis

Introduction

On October 31st I had the opportunity to deliver a presentation on youth suicide to the Sigourney Kiwanis. Kiwanis is a service organization that works with youth. This was a wonderful, active group that I enjoyed having the opportunity to speak with.

I’ve expanded on the point-form presentation that I left participants with, if you’re interested in reading more.

Suicide in Iowa

According to the Iowa Department of Public Health (Fleig, 2018) there were 478 suicide deaths in Iowa in 2018 including 39 teenagers. This is a large increase over the 2016 data kept by the CDC. 478 deaths means someone dies every 18 hours.

Suicide in General

For every suicide death, we know there are as many as 50 suicide attempts. (Schwartz-Lifshitz, et. al., 2012) This is partly because of the method that is used. The survival rate for firearm suicide is about 2%, for hanging it is about 30% and for overdose it is 98%. (Elnour & Harrison, 2008; Spicer & Miller, 2000)

Suicide Risk Factors

Anything that overwhelms someone’s coping and makes them feel hopeless may lead to suicidal behavior. Examples include:

  • Struggling in school
  • Anxiety or depression
  • Bullying
  • Substance abuse
  • Being a victim or survivor of abuse (physical, emotional, sexual)
  • Being a child of a parent who is struggling with substance abuse

Suicide Warning Signs

Warning signs are signs that a suicide attempt may be imminent. They include:

  • Giving away prized possessions
  • Talking about death
  • An unexpected peace or calm after a significant struggle (because the person has made the decision to attempt suicide)

Protective Factors Against Suicide

Protective factors are those things that help keep us safe from suicide or buffer us from suicide.

  • Academic Achievement
  • Parental and Non-Parental Connectedness (trusted adults)
  • Supportive Friendships
  • Involvement in Sports
  • Strong mental health / wellness

How You Can Help

Recognize Statements of Lethality

Also called statements of finality or invitations – invitations to ask about suicide – statements of lethality let us know that someone might be struggling with suicide. Statements of lethality include:

  • I can’t go on
  • I can’t do it anymore
  • I wish I was dead
  • I’m at the end of my rope

Ask Clearly About Suicide

You will not put the idea in the person’s head if you ask them about suicide. What you will do is help reduce the isolation and loneliness that person is feeling and reduce the intensity of those suicidal thoughts.

Limit Access to Lethal Means

Limiting access to lethal means, by securing firearms or locking up pills is an important part of safety planning with a vulnerable youth.

Take Intent Seriously

Additionally, take suicidal intent seriously. If a teenager overdoses on a harmless product like melatonin that they believe will hurt them, treat that like a serious suicide attempt.

Recognize Self-Injury is Different from Suicide

Recognize that non-suicidal self-injury (cutting) is separate from suicidal behavior and is usually a coping strategy rather than a means to an end.

Suicide Risk Assessment (CPR Model)

If someone has indicated that they are struggling with suicide, I want to know their current plan, their previous exposure to suicide and their resources/lack of resources.

Current Plan of Suicide

The more detailed their plan, the higher the risk level. Do they have access to the plan? Do they know when or where they want to carry out the plan? We know that taking away those means (e.g. securing the pills), in most cases does not cause an individual to try a different method. Instead, they step back and reconsider their suicide plan.

Previous Exposure to Suicide

Have they attempted before? If so, what’s different now? What’s changed? And have they ever lost someone close to them to suicide? If they have this increases their own risk for suicide.

Lack of Resources or Supports

A lack of resources like friends, family or counselling is one of the most significant risk factors for suicide.

Really Simple Suicide Intervention

If the youth can keep themselves safe today, tonight, tomorrow – then I’m okay with that. I can make an appointment for a counsellor or put other supports in place. If that youth can’t, then I’m going to call 911 or get them to the hospital for some emergency supports.

How Communities Can Help

Communities can form a Youth Suicide Prevention Action Group (YSP), this is a group that brings together members from different sectors like education, mental health, faith and law enforcement to work on resources to help reduce youth suicide.

Implementing an evidence-based program like Yellow Ribbon can help.

Hope for the Future

Senate File 2113 signed in March, requires teachers to get suicide awareness trained
(1 hour of Gatekeeper Training)

70% of those who attempt suicide and live will never make a second attempt because they get the help that they need. (Owens, Horrocks & House, 2002)

References

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Fleig, S. (2018, Oct 29) Following historically high suicide rates, Iowa schools become mental health ‘gatekeepers’. The Des Moines Register.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Schwartz-Lifshitz, M., Zalsman, G., Giner, L., & Oquendo, M. A. (2012). Can we really prevent suicide?. Current psychiatry reports14(6), 624-33.

Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American journal of public health90(12), 1885-91.

Cite this article as: MacDonald, D.K., (2018), "Youth Suicide Prevention with Kiwanis," retrieved on June 26, 2019 from http://dustinkmacdonald.com/youth-suicide-prevention-kiwanis/.
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Golan Model of Crisis Intervention

Introduction

Naomi Golan is the creator of the Golan Model of Crisis Intervention, and a pioneer of crisis theory and crisis intervention. She is Professor Emeritus at the University of Haifa in Israel, where she retired in 1984. (Dorfman, 2013)

Golan’s 1978 book Treatment in Crisis Situations provided a review of her three phase model of crisis intervention. While this work has been integrated into the work of modern day crisis intervention and even regular social work practice it was quite innovative in its day.

Golan Model of Crisis

The model that Golan proposes involves three stages or phases, and is designed to be completed in 5-6 sessions. The three phases are Assessment, Implementation and Termination. These are reviewed in more detail below.

Assessment

The assessment stage happens in the first session. The goals of the assessment stage are very similar to Boiling Down the Problem in the ABC Model and the Step 1 (Defining the Problem) in the Six Step Model of Crisis Intervention.

First, you must identify what the traumatic event or precipitating event that caused the crisis. Second, you must understand the client’s reaction or response to crisis. Third, what context did the crisis event happen in – what else is going on in the client’s life? The term “hazardous event” is sometimes used to describe the nature of the stressor. Fourth, you must identify how the client has been affected by the crisis, and finally what is the client’s primary concern as a result of the crisis?

Golan (1969) identifies four elements that can be used to determine if a client is in crisis:

  • a hazardous event
  • a vulnerable state
  • a precipitating factor
  • a state of active crisis or disequilibrium

A comprehensive assessment will be the road-map you rely on to ensure you have accurately understood the nature of the client’s crisis.

Implementation

Once you have identified the goals for treatment (collaboratively with the client), you will proceed to the Implementation phase. During implementation, you will collect information on the client’s pre-crisis functioning, coping strategies, strengths and weaknesses, and support systems available to them.

Once you have this information, you can begin to set some concrete goals with the client. For example, a recently divorced client who is completely overwhelmed with what to do next might set a goal to make an appointment with a career counsellor or resume writing service – or even something as simple as a checklist to ensure they shower and brush their teeth each morning.

The Implementation stage will run from the first session to approximately the fourth session.

Termination

Termination is the final sessions, which might be the 5th or 6th session. Now that the client has made some steps towards regaining pre-crisis functioning, the client and therapist make a plan to wrap up services and make plans for the future.

Similarities and Differences with Other Crisis Intervention Models

ABC Model

The ABC Model includes three stages:

  1. Achieving Rapport
  2. Boiling Down the Problem
  3. Contracting for Action

Similarities

Boiling Down the Problem most of the elements in the Implementation Phase, including understanding the elements that are leading the client to their crisis, and getting a detailed understanding of their coping strategies. The focus in the Termination model is very similar to the Contracting for Action part of the ABC Model.

Differences

The ABC Model includes achieving rapport as an explicit element, while the Golan Model does not, this is just expected. Additionally, the Termination phase in the Golan Model covers next steps after the client wraps up therapy, while the ABC Model may lead into regular counselling or therapy, without necessarily stopping therapy.

Six Step Model of Crisis Intervention

The Six Step Model of Crisis Intervention includes six steps:

  1. Defining the Problem
  2. Ensuring Client Safety
  3. Providing Support
  4. Examining Alternatives
  5. Making Plans
  6. Obtaining Commitment

Similarities

Both the Six Step Model and the Golan Model of Crisis Intervention include defining the nature of the problem, understanding their supports and existing resources, making goals or plans, and a termination or wrap up phase.

Differences

The Six Step Model includes more specific phases than the Golan Model. For example, Ensuring Client Safety (meeting their basic needs like shelter and food) and Providing Support (accepting the client as a person of value and worth) are absent from the Golan Model. On the other hand, the Golan Model includes assessing pre-crisis functioning in a way that the Six Step Model does not.

Finally, the Golan Model includes a more thorough Termination phase, while the Six Step Model’s Termination phase (“Obtaining Commitment”) is more about obtaining verbal agreement about next steps.

LAPC Model

The LAPC Model includes four steps:

  1. Listen
  2. Assess
  3. Plan
  4. Commit

Similarities

The LAPC Model’s Assess Phase is very similar to the Assessment Phase in the Golan Model, while the Plan Phase is very similar to the Implementation Phase. Finally, the Commit phase includes elements similar to those in the Termination phase of the Golan Model.

Differences

The main difference is that the LAPC Model includes a step involving Listening, while the Golan Model does not. Additionally, the LAPC Model includes safety planning and taking care of basic needs, things that were less of a concern to Golan – who was frequently taking care of clients in a hospital setting where this was already assumed.

Conclusion

As you can see, many crisis intervention models are overlapping and interrelated. The Golan Model of Crisis Intervention is a useful model of crisis intervention, and has several important similarities and differences when compared with other models like the Six Step Model, the ABC Model, and the LAPC Model.

References

Golan, N. (1969) When is a client in crisis?. Social Case Work. 50(7). pp. 389-394.

Golan, N. (1978) Treatment in Crisis Situations. New York, NY: Free Press.

Dorfman, R.A. (2013) Clinical Social WorkDefinition, Practice And Vision. London, England: Routledge.

Cite this article as: MacDonald, D.K., (2018), "Golan Model of Crisis Intervention," retrieved on June 26, 2019 from http://dustinkmacdonald.com/golan-model-crisis-intervention/.
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Suicide to Hope Workshop Review

Introduction

Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.

Conclusion

I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on June 26, 2019 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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Suicide Facts and Figures for Presentations

Introduction

For those of you who don’t use it, the website Quora is an absolute goldmine for information on a wide variety of topics. It allows you to ask and answer questions by individuals who all use their real names, and who have to identify their area of expertise (their reason for knowing the answer.)

One of the questions asked was “What are some striking facts or figures about suicide?” My answer is the basis for this post. I identify a number of suicide facts and figures with citations. These may make useful additions to presentations that you do in the future.

Suicide Attempts

We know that in the United States, about 50% of suicide deaths are by firearm (CDC, 2016). This accounts for the startling statistic that 60% of people who attempt suicide will die on their first attempt (Bostwick, et. al., 2016)

Of those that survive, 70% of those who live will never go on to have a second attempt, hopefully because they get the help that they need. About 23% will go on to attempt again (sometimes repeatedly) and live, while 7% will die on a future attempt. (Owens, Horrocks & House, 2002)

Gun owners in particular at much higher risk of suicide. We know that gun owners are 57 times more likely to die by suicide within 7 days of their purchase (likely because they purchased it specifically intent on suicide), and 7 times more likely within the first year as non-gun-owners. (Wintermule, et. al., 1999) Because of the high risk gun owners have for dying by suicide, a course like Counseling on Access to Lethal Means (CALM) can be extremely useful in having this difficult conversation.

Depending on the type of gun and other variables, 85-98% of firearm suicide attempts will end in death, while only about 2% of overdoses will end in death. (Elnour & Harrison, 2008).

Suicide Prevalence

Women attempt suicide about 3 times as frequently as men do (Vijayakumar, 2015) but tend to die 3 times more frequently (Varnik, 2012) chiefly because of their use of more lethal methods like firearm and hanging, when compared to women who more commonly use overdose.

Suicide is most common in the middle ages, accounting for 54% of suicides in Canada (Statistics Canada, 2013) and 51% of suicides in the United States (CDC, 2011).

Suicide Antecedents

It’s been suggested that up to 90% of those who die by suicide have a diagnosable mental illness (Bertole & Fleischmann, 2002). Although this figure has been challenged because it is based on psychiatric autopsies (reviews with those left behind) that might be vulnerable to bias, it is common enough to be valuable.

Conclusion

Did I miss any suicide facts and figures that you’d like to see? Let me know and I’ll update the article. Thanks all!

References

Bertolote, J.M. & Fleischmann, A. (2002) Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry. 1(3): 181-185.

Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100.

Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013, 2011) National Center for Injury Prevention and Control, CDC (producer). Available from http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2016) National Vital Statistics Report. 65(4). Retrieved on September 19, 2017 from https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Vijayakumar, L. (2015) Suicide in women. Indian Journal of Psychiatry. 57(Supp. 2). S233-S238. doi: 10.4103/0019-5545.161484.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Statistics Canada. (2013) CANSIM, table 102-0551 and Catalogue no. 84F0209X. Retrieved from http://www5.statcan.gc.ca/cansim/a26?id=1020551&

Varnik, P. (2012) Suicide in the World. International Journal of Environmental Research and Public Health. 9(3). 760-771. doi:  10.3390/ijerph9030760

Wintemute, G.J., Parham, C.A., Beaumont, J.J., Wright, M., & Drake, C. (1999) Mortality among recent purchasers of handguns. New England Journal of Medicine. 341(21):1583-9

Cite this article as: MacDonald, D.K., (2017), "Suicide Facts and Figures for Presentations," retrieved on June 26, 2019 from http://dustinkmacdonald.com/suicide-facts-figures-presentations/.
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Biopsychosocial Model of Suicidal Behaviour

Introduction

There are a variety of models of suicidal behaviour. These models attempt to map suicidal behaviour or put it into boxes so that a helping professional can better understand how suicidal behaviour forms and how it can be treated and resolved. This Biopsychosocial Model comes from Kumar, U. & Mandal, M.K. (2010).

The model is first presented in textual format, followed by an image, and then an explanation.

Biopsychosocial Model

Biological, Environmental and Event factors feed into a Psychological Process. This psychological process leads to the development or exacerbation of a mental health issue and to suicidal behaviour. On a cognitive level, this affects how the individual thinks and feels about the past, present and future.

 

 

 

 

 

 

 

 

 

 

 

 

 

Biological Influences in Suicide

There are a number of biological factors that can increase the risk of suicide which have been reviewed by Pandey (2013). These include genetic predisposition of suicidal behaviour (Turecki, 2001) which may be related to increased prevalence of impulsiveness and aggressiveness.

5HT receptors are receptors in the brain that are activated by the neurotransmitter serotonin. Serotonin plays an important role in mood (Yohn, Guerges & Samuels, 2017), appetite and eating (Sharma & Sharma, 2012), sleep, memory and sexual function. Improperly functioning 5HT receptors may play a role both in depression and in suicidal behavior.

It has been well-documented that teens and adolescents are more impulsive than adults as their brains continue to develop up to age 25 (Kasen, Cohen & Chen, 2011) and this can increase their risk of suicide and homicide. (Glick, 2015) Witt et. al. (2008) examines this through the lens of the Interpersonal Theory of Suicide – suggesting that impulsive individuals are more likely to have acquired capability (through being exposed to pain), which is one of the 3 key elements of that Theory of Suicide.

Environmental Influences in Suicide

Environmental influences on suicidal behaviour include literal environmental factors like sunlight exposure and situational factors like presence of abuse, history of suicide attempts and other items that are commonly known as suicide risk factors.

Souêtre et. al. (1990) found that decreased sunlight exposure and lowered temperature was linked to increased risk of suicide. This may explain the high rate of suicide in Nordic and Scandinavian countries that lack many of the other risk factors for suicide. Lam et. al. (1999) found that light therapy decreased suicidal ideation in a population of women who struggled with Seasonal Affective Disorder (SAD).

Evans, Owens & Marsh (2005) found that an external locus of control (believing that life “happens to one” rather than one having control over their life) was associated with an increased risk of suicide in adolescents. This likely holds true in adults as well.

Other risk factors for suicide include the American Association of Suicidology’s IS PATH WARM mnemonic:

  • Ideation (thoughts of suicide)
  • Substance Abuse
  • Purposelessness
  • Anxiety
  • Trapped (a feeling of being trapped)
  • Hopelessness
  • Withdrawal (from others)
  • Anger
  • Recklessness
  • Mood Changes

Event Influences in Suicide

Sometimes an event occurs in someone’s life that is so devastating that it may lead to suicide. For instance, relational changes and other interpersonal issues (such as a loss of a relationship or fights with a friend) commonly precede a suicide attempt (Yen et. al., 2005; Bagge, Glenn & Lee, 2013; Conner, et. al., 2012)

In addition to interpersonal events as described above, events that may lead to suicidal behaviour include being arrested, charged or sentenced with a crime (Cooper, Appleby & Amos, 2002). Zhang & Ma (2012) also found this in a Chinese sample of suicide attempters, with the most common stressful life events preceding suicide involving family/home, hospital/health and marriage/love.

Conclusion

It’s clear that the biopsychosocial model of suicide has a fair amount of support for its component parts. It may be difficult to apply the Biopsychosocial Model directly in a clinical or therapeutic context. For that reason, other models may be preferred for intervention purposes.

References

Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology122(2), 359-368. doi:10.1037/a0030371

Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013

Cooper, J., Appleby, L., & Amos, T. (2002). Life events preceding suicide by young people. Social Psychiatry & Psychiatric Epidemiology37(6), 271.

Evans, W. P., Owens, P., & Marsh, S. C. (2005). Environmental Factors, Locus of Control, and Adolescent Suicide Risk. Child & Adolescent Social Work Journal22(3/4), 301-319. doi:10.1007/s10560-005-0013-x

Glick, A. R. (2015). The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: a literature review. International Journal Of Adolescent Medicine And Health, (2), 143. doi:10.1515/ijamh-2015-5005

Kasen, S., Cohen, P., & Chen, H. (2011). Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide And Life-Threatening Behavior, (2), 180.

Kumar, U & Mandal, M.K. (2010). Suicidal Behavior: Assessment of People-at-Risk. New Delhi, India: SAGE Publications.

Lam, R. W., Carter, D., Misri, S., Kuan, A. J., Yatham, L. N., & Zis, A. P. (1999). A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Research86185-192. doi:10.1016/S0165-1781(99)00043-8

Pandey, G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar Disorders15(5), 524-541. doi:10.1111/bdi.12089

Sharma, S., & Sharma, J. (2012). Regulation of Appetite: Role of Serotonin and Hypothalamus. Iranian Journal Of Pharmacology & Therapeutics11(2), 73-79.

Souêtre, E., Wehr, T.A., Douillet, P. & Darcourt, G. (1990) Influence of environmental factors on suicidal behavior. Psychiatry Research. 32(3):253-63.

Turecki, G. (2001). Suicidal behavior: is there a genetic predisposition?. Bipolar Disorders3(6), 335-349.

Witte, T. K., Merrill, K. A., Stellrecht, N. E., Bernert, R. A., Hollar, D. L., Schatschneider, C., & Joiner, J. E. (2008). Research report: “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal Of Affective Disorders107107-116. doi:10.1016/j.jad.2007.08.010

Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology73(1), 99-105. doi:10.1037/0022-006X.73.1.99

Yohn, C. N., Gergues, M. M., & Samuels, B. A. (2017). The role of 5-HT receptors in depression. Molecular Brain101-12. doi:10.1186/s13041-017-0306-y

Zhang, J., & Ma, Z. (2012). Research report: Patterns of life events preceding the suicide in rural young Chinese: A case control study. Journal Of Affective Disorders140161-167. doi:10.1016/j.jad.2012.01.010

Cite this article as: MacDonald, D.K., (2017), "Biopsychosocial Model of Suicidal Behaviour," retrieved on June 26, 2019 from http://dustinkmacdonald.com/biopsychosocial-model-suicidal-behaviour/.
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