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Word count as an indicator of suicide risk in an inpatient setting

The current study replicates a previously used methodology with a suicidal inpatient sample regarding word counts generated by participants writing about suicidal constructs. Word counts (i.e., the number of written words) on the Suicide Status Form from initial sessions with suicidal inpatients were compared to self-rated suicide risk scores as well as to continuous and repeated measures of hopelessness and suicide ideation assessed over the course of inpatient care. Results showed that higher word counts were associated with initially higher suicide ideation scores that steadily declined over the course of treatment. Lower word counts were associated with lower initial hopelessness scores that increased during treatment before ultimately decreasing. In addition, word count was not found to be a significant predictor of self-rated suicide risk. Clinical implications of these data and future directions are discussed.

References

  • Andreasson K., , Krogh J., , Wenneberg C., , Jessen H. K., , Krakauer K., , Gluud C., , … Nordentoft M. (2016). Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality traits and disorder—A randomized observer-blinded clinical trial. Depression and Anxiety, 33, 520–530. Crossref MedlineGoogle Scholar
  • Beck A. T. (1988). Cognitive approaches to panic disorder: Theory and therapy. In Rachman S., & Maser J. D. (Eds.), Panic: Psychological perspectives (pp. 91–109). Hillsdale, NJ: Lawrence Erlbaum Associates. Google Scholar
  • Beck A. T., , Brown G. K., , & Steer R. A. (1997). Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Behaviour Research and Therapy, 35, 1039–1046. Crossref MedlineGoogle Scholar
  • Beck A. T., , Kovacs M., , & Weissman A. (1975). Hopelessness and suicidal behavior: An overview. Journal of the American Medical Association, 234, 1146–1149. Crossref MedlineGoogle Scholar
  • Beck A., , & Steer R. (1988). Manual for the Beck Hopelessness Scale. San Antonio, TX: Psychological Corp. Google Scholar
  • Beck A. T., , Steer R. A., , Kovacs M., , & Garrison B. (1985). Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. American Journal of Psychiatry, 142, 559–563. Crossref MedlineGoogle Scholar
  • Beck A. T., , Steer R. A., , & Ranieri W. F. (1988). Scale for Suicide Ideation: Psychometric properties of a self-report version. Journal of Clinical Psychology, 44, 499–505. Crossref MedlineGoogle Scholar
  • Brancu M., , Jobes D., , Wagner B., , Greene J., , & Fratto T. (2016). Are there linguistic markers of suicidal writing that can predict the course of treatment? A repeated measures longitudinal analysis. Archives of Suicide Research, 20, 438–450. Crossref MedlineGoogle Scholar
  • Brown G. K., , Steer R. A., , Henriques G. R., , & Beck A. T. (2005). The internal struggle between the wish to die and the wish to live: A risk factor for suicide. American Journal of Psychiatry, 162, 1977–1979. Crossref MedlineGoogle Scholar
  • Colley A., , & Todd Z. (2002). Gender-linked differences in the style and content of e-mails to friends. Journal of Language and Social Psychology, 21, 380–392. CrossrefGoogle Scholar
  • Comtois K. A., , Jobes D. A., , O'Connor S. S., , Atkins D. C., , Janis K., , Chessen C. E., , … Yuodelis-Flores C. (2011). Collaborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety, 28, 963–972. Crossref MedlineGoogle Scholar
  • Conrad A. K., , Jacoby A. M., , Jobes D. A., , Lineberry T. W., , Shea C. E., , Arnold Ewing T. D., , … Kung S. (2009). A psychometric investigation of the Suicide Status Form II with a psychiatric inpatient sample. Suicide and Life-Threatening Behavior, 39, 307–320. LinkGoogle Scholar
  • Corona C. D., , Jobes D. A., , Nielsen A. C., , Pedersen C. M., , Jennings K. W., , Lento R. M., , & Brazaitis K. A. (2013). Assessing and treating different suicidal states in a Danish outpatient sample. Archives of Suicide Research, 17, 302–312. Crossref MedlineGoogle Scholar
  • Ellis T. E., , Daza P., , & Allen J. G. (2012). Collaborative Assessment and Management of Suicidality at Menninger (CAMS-M): An inpatient adaptation and implementation. Bulletin of the Menninger Clinic, 76, 147–171. LinkGoogle Scholar
  • Ellis T. E., , Green K. L., , Allen J. G., , Jobes D. A., , & Nadorff M. R. (2012). Collaborative assessment and management of suicidality in an inpatient setting: Results of a pilot study. Psychotherapy, 49, 72–80. Crossref MedlineGoogle Scholar
  • Ellis T. E., , Rufino K. A., , & Allen J. G. (2017). A controlled comparison trial of the Collaborative Assessment and Management of Suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six-month follow-up. Psychiatry Research, 249, 252–260. Crossref MedlineGoogle Scholar
  • Ellis T. E., , & Rutherford B. (2008). Cognition and suicide: Two decades of progress. International Journalof Cognitive Therapy, 1, 47–68. LinkGoogle Scholar
  • Foa E. B., , Riggs D. S., , Massie E. D., , & Yarczower M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26, 487–499. CrossrefGoogle Scholar
  • Garber J., , Little S., , Hilsman R., , & Weaver K. R. (1998). Family predictors of suicidal symptoms in young adolescents. Journal of Adolescence, 21, 445–457. Crossref MedlineGoogle Scholar
  • Ho T. P., , Yip P. S. F., , Chiu C. W. F., , & Halliday P. (1998). Suicide notes: What do they tell us? Acta Psychiatrica Scandinavica, 98, 467–473. Crossref MedlineGoogle Scholar
  • Jobes D. A. (2012). The collaborative assessment and management of suicidality (CAMS): An evolving evidence-based clinical approach to suicidal risk. Suicide and Life-Threatening Behavior, 42, 640–653. Crossref MedlineGoogle Scholar
  • Jobes D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). New York, NY: Guilford Press. Google Scholar
  • Jobes D. A., , Comtois K., , Brenner L., , Gutierrez P., , & O'Connor S. (2016). Lessons learned from clinical trials of the Collaborative Assessment and Management of Suicidality (CAMS). In O'Connor R. C., , Platt S., , & Gordon J. (Eds.), International handbook of suicide prevention: Research, policy, & practice (2nd ed., pp. 431–449). West Sussex, UK: Wiley-Blackwell. CrossrefGoogle Scholar
  • Jobes D. A., , Comtois K. A., , Gutierrez P. M., , Brenner L. A., , Huh D., , Chalker S. A., , … Crow B. (2018). A randomized controlled trial of the collaborative assessment and management of suicidality versus enhanced care as usual with suicidal soldiers. Psychiatry: Interpersonal and Biological Processes, 80, 339–356. CrossrefGoogle Scholar
  • Jobes D. A., , Jacoby A. M., , Cimbolic P., , & Hustead L. A. T. (1997). Assessment and treatment of suicidal clients in a university counseling center. Journal of Counseling Psychology, 44, 368–377. CrossrefGoogle Scholar
  • Jobes D. A., , & Mann R. E. (1999). Reasons for living versus reasons for dying: Examining the internal debate of suicide. Suicide and Life-Threatening Behavior, 29, 97–104. MedlineGoogle Scholar
  • Jobes D. A., , Nelson K. N., , Peterson E. M., , Pentiuc D., , Downing V., , Francini K., , & Kiernan A. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34, 99–112. LinkGoogle Scholar
  • Kahn-Greene E. (2009). Chronic vs. acute suicidal risk: A pre-post study of inpatient psychiatric hospitalizations (Unpublished doctoral dissertation). The Catholic University of America, Washington, DC. Google Scholar
  • Kovacs M., , & Beck A. T. (1977). The wish to die and the wish to live in attempted suicides. Journal of Clinical Psychology, 33, 361–365. Crossref MedlineGoogle Scholar
  • Kring A. M., , & Gordon A. H. (1998). Sex differences in emotion: Expression, experience, and physiology. Journal of Personality and Social Psychology, 74, 686–703. Crossref MedlineGoogle Scholar
  • Lanza S. T., , Bray B. C., , & Collins L. M. (2012). An introduction to latent class and latent transition analysis. In Weiner I. B., , Schinka J. A., , & Velicer W. F. (Eds.), Handbook of psychology: Research methods in psychology (2nd ed., pp. 691–716). Hoboken, NJ: Wiley. Google Scholar
  • Lento R. M., , Ellis T. E., , Hinnant B. J., , & Jobes D. A. (2013). Using the suicide index score to predict treatment outcomes among psychiatric inpatients. Suicide and Life-Threatening Behavior, 43, 547–561. MedlineGoogle Scholar
  • Lynch T. R., , Cheavens J., , Morse J. Q., , & Rosenthal M. (2004). A model predicting suicidal ideation and hopelessness in depressed older adults: The impact of emotion inhibition and affect intensity. Aging & Mental Health, 8, 486–497. Crossref MedlineGoogle Scholar
  • Maxwell S. E., , Delaney H. D., , & Kelley K. (2017) Designing experiments and analyzing data: A model comparison perspective (3rd ed.) New York, NY: Routledge. CrossrefGoogle Scholar
  • McIntosh J. L., & Drapeau C. W. (2016). U.S.A. suicide 2015: Official final data. American Association of Suicidology: Washington, DC. Retrieved from http://www.suicidology.org/resources/facts-statistics Google Scholar
  • O'Donnell I., , Farmer R., , & Catalan J. (1993). Suicide notes. British Journal of Psychiatry, 163, 45–48. Crossref MedlineGoogle Scholar
  • Pennebaker J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162–166. CrossrefGoogle Scholar
  • Pennebaker J. W., , & Seagal J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243–1254. Crossref MedlineGoogle Scholar
  • Peterson-Fleming E. (2004). Assessing suicide risk and predicting treatment outcomes: The role of suicide history, Suicide Status Form qualitative response, and response style (Unpublished doctoral dissertation). The Catholic University of America, Washington, DC. Google Scholar
  • Rudd M. D. (2000). The suicidal mode: A cognitive-behavioral model of suicidality. Suicide and Life-Threatening Behavior, 30, 18–33. MedlineGoogle Scholar
  • Shek D. T., , & Ma C. M. (2011). Longitudinal data analyses using linear mixed models in SPSS: Concepts, procedures and illustrations. Scientific World Journal, 11, 42–76. CrossrefGoogle Scholar
  • Shneidman E. (1985). Definition of suicide. Northvale, NJ: Jason Aronson. Google Scholar
  • Smyth J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–184. Crossref MedlineGoogle Scholar
  • Stone G. (2011). Self-orientation and relational-orientation in suicidal risk: Possible facilitative and protective aspects (Unpublished doctoral dissertation). The Catholic University of America, Washington, DC. Google Scholar
  • Watson D., , & Clark L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96, 465–490. Crossref MedlineGoogle Scholar
  • Weinberger D. A., , Schwartz G. E., , & Davidson R. J. (1979). Low-anxious, high-anxious, and repressive coping styles: Psychometric patterns and behavioral and physiological responses to stress. Journal of Abnormal Psychology, 88, 369–380. Crossref MedlineGoogle Scholar
  • Wenzel A., & Beck A. T. (2008). A cognitive model of suicidal behavior: Theory and treatment. Applied and Preventive Psychology, 12, 189–201. CrossrefGoogle Scholar
  • Wenzlaff R. M., , & Wegner D. M. (2000). Thought suppression. Annual Review of Psychology, 51, 59–91. Crossref MedlineGoogle Scholar
  • West B., , Welch K. B., , & Galecki A. T. (2006). Linear mixed models: A practical guide using statistical software. Boca Raton, FL: Chapman & Hall/CRC. CrossrefGoogle Scholar