The American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management

Reviews / Votes

This third edition offers updates on many topics and new
chapters devoted to sleep and suicide risk, neuromodulation treatments, and
teaching psychiatry residents about suicide. It balances the most high-yield
topics while giving attention to scenarios that need more research but are
immediately clinically relevant. The community pharmacy and telehealth
settings are newer areas for exploring suicide risk and management, which
may be included in future editions. This is critical reading for all
psychiatrists. -- Daniel M Tuinstra, M.D. * Doody's Book Reviews * Even as suicide rates have decreased globally in
recent
years, and despite significant prevention
efforts, US suicide rates have
risen 35% since
2000.1 Some predict that rates will increase
still
further in the wake of the economic stress and
social
isolation brought about by the coronavirus
disease 2019 (COVID-19)
pandemic.2,3 Thus,
publication of the third edition of the
American
Psychiatric Association Publishing Textbook of
Suicide Risk
Assessment and Management is both
welcome and timely.
This edition's
structure parallels that of the previous edition, including sections on risk
assessment
and treatment, major disorders, treatment
settings,
prevention, and special topics. Each chapter provides a useful
conclusion paragraph and summary
bullet points. Notably, this volume is
significantly
smaller than its predecessor (477 vs. 744
pages),
specifics of which are discussed below.
Considering recent
failures to reduce the toll of
suicide in the United States, it is
encouraging that
the scientific field of suicide studies has
recently
begun to see much-needed change, with movement
from the
traditional view of suicide as simply a
symptom of mental illness to
newer models that
approach suicide as a transdiagnostic issue of primary
clinical focus. In this framework, interventions
are designed
specifically around the unique needs of
suicidal individuals, with
similarities in suicidal
processes across diagnoses outweighing the
differences. These processes include such
transdiagnostic
vulnerabilities as cognitive rigidity,
hopelessness,
deficient problem-solving, emotion
dysregulation,
acquired capability, and sleep disturbance.4,5
The
third edition of this textbook commendably
reflects this evolution,
although not to the extent
that one might wish. For example, an
excellent
chapter on depressive disorders contains a lengthy
section
on transdiagnostic considerations, yet the
book continues with separate
chapters on various
disorders, without much discussion of how
suicidal
and nonsuicidal patients with the same diagnosis
differ in
terms of treatment needs. A transdiagnostic approach, on the other hand,
would help
explain why only a small percentage of people with
a
given psychiatric disorder die by suicide and how
they differ from
patients who do not.
The reduced size of the new edition is
especially
noticeable in the area of risk assessment, where
5
chapters are reduced to only 1; largely missing is
guidance beyond
what information one should
gather regarding risk factors and warning
signs to
coverage of how to obtain valid information in such
a
sensitive area. Few details are provided on systems such as the Chronologic
Assessment of Suicide
Events (CASE) approach6 or The
Collaborative
Assessment and Management of Suicidality
(CAMS)
framework,7 both of which provide structured, evidence-based methods for
addressing a
topic that most patients (and many clinicians)
would
prefer to avoid. Similarly, treatment chapters
such as the one on
cognitive-behavior therapy are quite brief and primarily descriptive, with
little in
the way of "how-to's" to guide the clinician.
The
presentation of information improves considerably in later portions of the
book. For example,
the chapter on sleep and suicide not only
presents
an overview of relevant theory and research but
also
provides detailed discussions of the management of insomnia and nightmares.
Likewise, the
chapter on firearms and suicide provides
excellent
guidance for practitioners on navigating the challenging
waters of reducing access to firearms by
people at risk for
suicide.
The chapter, perhaps most likely to show the
reader that
"times have changed" is the updated
chapter on social media and the
internet. In it, we
see the 2-edged sword of the digital world,
which
includes both potentially life-saving resources and
darker
areas where bullying, taunting, and even
"digital self-harm" lurk.
Included in this chapter is
a highly useful list of suggested clinical
interview
questions and prompts regarding internet issues
of
possible relevance to suicide risk.
Despite its reduced size, the
new edition does add
chapters on topics that were not present in
the
previous edition, including chapters on college and
university
students, self-injurious behavior
(including nonsuicidal self-injury),
and physicianassisted dying. The last of these commendably
considers
whether the term "physician-assisted
suicide" should be retired in cases
of terminally ill
individuals who typically do not wish to die but
also
do not want themselves or their families to go
through a
lingering, painful dying process. This
chapter includes an excellent
overview of the status
of assisted dying laws across the United States
and
internationally.
Overall, the American Psychiatric
Association
Publishing Textbook of Suicide Risk Assessment
and
Management, Third Edition, follows in the
footsteps of previous editions
as a quality reference
volume. It is authoritative, digestible, and
applicable to practice in multiple settings, whether
academic,
correctional, inpatient, outpatient, or
emergency care. In areas where
it is lacking in
detail, it provides the reader with ample ideas
on
where one might obtain further information or
training. As such,
it continues to be an important
resource in the libraries of practicing
psychiatrists,
other mental health professionals, and professionals in
training. -- Thomas E. Ellis, PsyD, ABPP * Journal of Psychiatric Practice *