Suicide is the 10th leading cause of death in the United States. It is the only cause of death among the top 20 listed that has experienced a rise in ranking. Suicide rates for those 40-65 years old are undergoing the sharpest increase. Furthermore, 60 percent of completed suicides are successful on the first attempt. Is there any way to see the danger in order to intervene in time? Attendees at this year’s annual meeting of the American Psychiatric Association heard a report from Dr. Igor Galynker, MD, PhD, in which he described his ongoing efforts to develop a predictive tool that could warn of a patient’s risk of suicide. Dr. Galynker’s work on the Suicide Trigger Scale is funded by the American Foundation for Suicide Prevention. There are a number of risk factors involved with suicide. The primary risk is having a psychiatric disorder, but chronic physical illnesses, history of attempted suicide, insufficient social support and suicidal ideation also contribute. While suicidal ideation is a contributing risk factor, it is not as predictive as some may believe. Ideation reflects a thinking process, but suicide is not always premeditated. Rather than resulting from a thinking process, suicide is often the result of an affective state. In fact, often no more than 10 minutes elapse between a person’s thought of suicide and an actual attempt. Dr. Galynker explained that, for this reason, his Trigger Scale has no questions pertaining to thoughts of suicide. Instead, his questionnaire focuses on feelings. Feelings, Dr. Galynker said, are older than ideas. The most important question on his scale has to do with a person’s feeling of entrapment. During his talk, Dr. Galynker outlined some dominant themes among those who attempt or commit suicide. Among them are: non-reality based physical sensations, uncontrollable hopelessness and a fear of entrapment. So long as a person feels that there exists a possibility of escaping their current pain, the hope can motivate. Patients who lose that hope and feel trapped give in to fatalism, sometimes even reporting a sense of imminent doom. The scale is being developed through a set of questionnaires administered to 300 inpatient subjects over a 1.5-year period. Dr. Galynker and his team see patients within the initial 24 hours of their admittance to inpatient care and administer the 40-question test. These interviews are followed up at two-month and one-year intervals. The team also administers a Symptom Checklist 90-R to help predict the likelihood of a suicide attempt within the coming year. To date, high scores on the Trigger Scale seem to correlate with prior suicide attempts, with lower Trigger Scale scores pointing to suicidal ideation. The audience of psychiatrists to whom Dr. Galynker made his address was sadly acquainted with the pain of suicide. For them as well as for those struggling with severe anxiety issues along with their families, the hope of a predictive tool is strong.
