SEATTLE — An American Association of Suicidology expert consensus panel has developed the first evidence-based list of warning signs for suicide—and fashioned a mnemonic designed to help get out the message.
Here's the mnemonic, which AAS officials hope to disseminate widely as an easy aid to addiction specialists, emergency medicine specialists, primary care physicians, and the general public in identifying individuals at heightened suicide risk: IS PATH WARM?
IS PATH WARM? is an attempt to introduce a semblance of order and coherence into what until now have been the totally chaotic efforts of a multitude of organizations trying to assist the public and non-mental health clinicians to spot those in need of help, M. David Rudd, Ph.D., explained at the annual meeting of the American Association of Suicidology.
To illustrate the current chaos, he described his Internet search on Google using the key words “warning signs” and “suicide,” which returned more than 180,000 hits. He and his coinvestigators then selected 200 of the most popular Web sites for closer examination and determined those sites collectively listed 3,266 warning signs for suicide, many of them duplicates.
“Try to put that on a card you can carry in your wallet,” quipped Dr. Rudd, the association's immediate past-president and chair of the department of psychology at Texas Tech University, Lubbock.
Next, the investigators scrutinized a random selection of 50 of the 200 Web sites. They counted 138 distinct suicide warning signs listed therein, almost none of them evidence based. For example, among the purported warning signs was phoning one's grandparents, which is hardly specific for suicidality.
“If I asked, what are the warning signs for stroke, heart attack, or diabetes, just about everybody in this room could give me a pretty accurate representative list. I think it's a tragedy that, in this field, we can't offer a coherent, consistent, compact, and empirically supported list of warning signs for suicide,” Dr. Rudd continued. “When you can get on the Internet and find 3,200 warning signs, all we're doing is confusing the public. What happens is you get people intervening in entirely inappropriate circumstances. This mnemonic is an effort to try to stop that.”
AAS Executive Director Lanny Berman, Ph.D., conceded the sensitivity and specificity of IS PATH WARM? for suicidal behavior “is not great.” Indeed, the warning signs referred to in the mnemonic are associated with evidence of increased risk of suicidal activity sometime within the next 12 months.
“We don't have research that says, 'In the next 24 hours, or 48 hours, or 3 months.' We're not at that stage,” he said.
But that doesn't unduly bother Dr. Morton M. Silverman, editor of the AAS journal Suicide and Life-Threatening Behavior.
“We teach everyone that when they have a lump in their breast, they need to go see their physician. We teach everyone that when have chest pain, they'd better get medical attention. It doesn't mean that the chest pain is a heart attack or the lump in the breast is necessarily breast cancer. But those are warning signs that something might be amiss,” said Dr. Silverman, also the senior adviser to the Suicide Prevention Resource Center and a psychiatrist at University of Chicago.
“Warning signs do not equal suicide,” he stressed. “They are prompts that should get an individual to seek help or get a clinician to do a proper suicide risk assessment.”
Dr. Berman was disappointed that other mental health organizations, such as the American Academy of Child and Adolescent Psychiatry and American Psychological Association, have yet to adopt IS PATH WARM?
IS PATH WARM? Spells Warning
Signs of Suicide:
I Ideation
S Substance abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood changes
Source: American Association of Suicidology