Clinical judgments by mental health professionals in assessing the seriously suicidal adolescent
There are two levels of lethality for danger of death due to suicide: risk for suicide and imminent danger to one's life. This study examined how experienced clinicians in three clinical settings distinguish adolescents who are at risk and those whose lives are in imminent danger due to his or her suicidality.
Ninety mental health professionals from three treatment settings, Crisis Intervention Centers, Private Practitioners, and Adolescent Outpatient Programs, with 12.3 mean years experience assessing suicidal adolescents were surveyed in order to determine how they formulate clinical judgment in identifying levels of suicidal risk in adolescents.
Phase 1 was to ensure that the review of the literature yielded a broad and content valid domain of variables for use in Phase 2, the main data collection phase. In Phase 1, suicidologists developed a list of factors they believed differentiated the seriously suicidal adolescent from the nonlethal suicidal adolescent. In Phase 2, clinicians rated 15 literature-generated variables on importance and frequency in differentiating the seriously from less seriously suicidal adolescent, completed a matrix on the degree to which factors occur together in the seriously suicidal adolescent, and stated in general how they assess the level of seriousness of suicidal risk in their teenage clients.
There were no significant differences according to treatment setting, theoretical orientation, and discipline on importance and frequency ratings by the participants. Multidimensional scaling procedures showed that clinicians perceive variables in three dimensions. Examination of the stimulus configurations based on the three dimensional solutions revealed that the suicidal risk factors formed three broad clusters: "Psychiatric history", "Negative Emotional States", and "Negative Life Events". Some factors consistently stood outside of the broad clusters while others did not fall into any specific cluster. There were no significant differences between importance ratings by suicidologists on the 15 literature-generated variables, and clinicians from the three treatment setting groups. This result suggests the clinicians surveyed do use the distinguishing characteristics as identified in the literature in making clinical judgments in assessing the seriously suicidal adolescent. These findings underscore the validity and usefulness of ideas about suicidal adolescents gleaned from literature and empirical research. (Abstract shortened with permission of author.)