Risk Factors for Suicide: What therapists should know when treating teens and adults

Sep 26, 2022

Risk Factors for Suicide: What therapists should know when treating teens and adults

Curt and Katie chat about suicide risk factors. Suicide rates have been increasing across the nation and there is an increasing need for the mental health workforce to be prepared to assess and intervene with clients of all ages. We take an in-depth look at the risk and protective factors associated with suicidal ideology and behaviors in both teens and adults. We also lay the beginning foundations of a suicide model to help clinicians better understand and intervene with clients exhibiting suicidal thoughts. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore what makes someone more likely to attempt suicide

We’ve talked frequently about suicide, but thought it would be important, especially during Suicide Prevention Awareness Month, to go more deeply into the risk factors that make someone more likely to attempt and complete suicide.

What are the highest risk factors for suicide?

“Anxiety Sensitivity… the fear of the feelings of being anxious… is even more so correlated with suicidal ideation and suicide attempts than depression is.” – Curt Widhalm, LMFT

Defining acute, active suicidality (versus passive or chronic suicidality or non-suicidal self-Injury)
Going beyond the list of risk factors to how big of a risk each factor is for attempting or completing suicide
Exploring how impactful a previous attempt is on whether someone is likely to attempt of complete suicide
The importance of getting a complete history of suicidality and suicide attempts at intake
The impact of family members who have attempted or died by suicide
Alcohol and other substance use and abuse as an additive risk factor
Cooccurring mental disorders (eating disorders, psychosis and serious mental illness, depression, anxiety and anxiety sensitivity, personality disorders)
Child abuse history, especially folks with a history of sexual abuse history
Life transitions, especially unplanned and sudden life transitions
Owning a firearm makes you 50 times more likely to die by suicide
Racial differences in who is more likely to attempt or complete suicide
Living at a high elevation

What are additional risk factors for suicide specific to teens?

Early onset of mental illness
Environmental factors
Exposure to other suicides (social media, contagion)
Not being able to identify other options
Seeking control over their lives and lacking impulse control leading to suicide attempts
The importance of communication and the potential for a lack of communication
Bullying and lack of social support, without a way to escape due to social media and cell phones

What are protective factors when assessing for suicidality?

“Just because protective factors are present doesn't mean that they balance out risk factors [for suicide].”– Curt Widhalm, LMFT

Reasons for living, responsibility to others
Spirituality or attending a place of worship that teaches against suicide
Where you live based on cultural or societal factors
Having a children or child-rearing responsibilities, intact marriage
Strong social support, employment
Relationship with a therapist

Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

Reviewing the model shown in the graphic in the show notes at mtsgpodcast.com

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Information on the ACEs Study

References mentioned in this continuing education podcast:

Bodell, L. P., Cheng, Y., & Wildes, J. E. (2019). Psychological Impairment as a Predictor of Suicide Ideation in Individuals with Anorexia Nervosa. Suicide & life-threatening behavior, 49(2), 520–528. https://doi.org/10.1111/sltb.12459

Borges, G., Bagge, C. L., Cherpitel, C. J., Conner, K. R., Orozco, R., & Rossow, I. (2017). A meta-analysis of acute use of alcohol and the risk of suicide attempt. Psychological medicine, 47(5), 949–957. https://doi.org/10.1017/S0033291716002841

Bostwick, C. Pabbati, J. Geske, A. McKean (2016) Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew Am. J. Psychiatry, 173 (11), pp. 1094-1100, 10.1176/appi.ajp.2016.15070854

Brådvik, L. Suicide risk and mental disorders. Int. J. Environ. Res. Public Health 2018, 15, 2028

Campisi, S.C., Carducci, B., Akseer, N. et al. (2020) Suicidal behaviours among adolescents from 90 countries: a pooled analysis of the global school-based student health survey. BMC Public Health 20, 1102. https://doi.org/10.1186/s12889-020-09209-z

Doyle, M., While, D., Mok, P.L.H. et al. Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study. BMC Fam Pract 17, 106 (2016). https://doi.org/10.1186/s12875-016-0479-y

Martin, M.S., Dykxhoorn, J., Afifi, T.O. et al. (2016) Child abuse and the prevalence of suicide attempts among those reporting suicide ideation. Soc Psychiatry Psychiatr Epidemiol 51, 1477–1484. https://doi.org/10.1007/s00127-016-1250-3

O'Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. 2018;373

Stanley, I. H., Boffa, J. W., Rogers, M. L., Hom, M. A., Albanese, B. J., Chu, C., Capron, D. W., Schmidt, N. B., & Joiner, T. E. (2018). Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. Journal of consulting and clinical psychology, 86(11), 946–960. https://doi.org/10.1037/ccp0000342

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019, March 14). Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide-Related Outcomes in a Nationally Representative Dataset, 2005–2017. Journal of Abnormal Psychology. Advance online publication. http://dx.doi.org/10.1037/abn0000410

*The full reference list can be found in the course on our learning platform.

Relevant Episodes of MTSG Podcast:

Rage and Client Self-Harm: An interview with Angela Caldwell

How to Understand and Treat Psychosis: An interview with Maggie Mullen

Navigating the Food and Eating Minefield: An interview with Robyn Goldberg

How Therapists Promote Diet Culture: An interview with Rachel Coleman

The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW

Working with Trans Clients: Trans Resilience and Gender Euphoria: An interview with Beck Gee-Cohen

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.