by William Van Ornum, Ph.D. on
I was fortunate to be at the Boat Basin on Saturday morning May 7, 2011, when Evander Lomke, executive director of AMHF, presented Suicide Prevention International (SPI) with only the second Stefan de Schill Award. We were celebrating this at the West Side Boat Basin in Riverside Park. At least one-hundred enthusiastic persons, young and old, gathered together to raise money for SPI with a brisk jaunt north along the Hudson River. Prior to the start, we celebrated the lifework of Stefan de Schill.
One of Dr. de Schill’s enduring goals for and contributions to mental health was to make effective mental-health services available to the widest number of persons. One way that he did this was through encouraging and providing group therapy, which is not only a cost-effective treatment but offers strategic advantages over individual therapy.
Suicide Prevention International’s contributions to mental health follow in Stefan’s tradition, although in a different manner, one that is particularly needed in the times we live in. Right now, many veterans are returning from the Mideast with depression, posttraumatic stress disorder (PTSD), and hopeless thinking: ingredients that can engender suicidal thinking and hopelessness. Mental-health professionals know from sad experience that predicting suicide is one of the thorniest questions in the field.
Dr. Hendin and his research team created a psychological test for assessing suicide risk, the Affective States Questionnaire (ASQ), published in the prestigious peer-reviewed Journal of Nervous and Mental Disease (March 2010-Volume 198-Issue 3-pp 220-25-doi: 10.1097/NMD.0b013e3181d13d14).
One of the difficulties in creating a psychological-screening test for suicide potential is the problem of balancing false positives with false negatives. A false positive on a test is when you identify someone as having the quality you are looking for, when they really don’t have it. So a false positive on a suicide prevention test means you identify someone as having high suicide potential, when in reality this is not the case. A disadvantage of having too many false positives is that you end up providing intense (and expensive) medical treatment to persons who don’t require this.
The problem of false negatives can be especially worrisome on a test of suicide potential: a false negative here will claim that someone does not have high suicide risk, when in reality they do. So this kind of identification can lead to a lack of treatment and lack of therapeutic attention, with sometimes fatal results.
Dr. Hendin and his team gave the ASQ to patients in a Veteran’s Administration hospital program during the initial interview and work-up, and again three months later. At the second administration of the test, it was possible to examine any suicidal behaviors that had occurred during the previous three months. They reported that the ASQ had good sensitivity for predicting suicidal behavior during the follow-up period. The test had a low rate for false positives when given to a control group. The researchers concluded, “The ASQ is able to improve significantly our ability to predict acute suicidal risk in a clinical psychiatric population.”
We congratulate Dr. Herbert Hendin and the Suicide Prevention International nonprofit organization not only for this latest contribution to the field, but for their many other contributions.