Substitute Assignment Work Group 5.

-- SUICIDE PREVENTION AND ROM QUESTIONNAIRES –

STEP 1 – Suicide prevention e-learning exercise
Interpersonal Psychology Theory (IPT)
Rob is a middle-aged man battling extreme hopelessness. In relation to Joiner's
Interpersonal Psychology Theory (IPT) regarding suicide ideation, a person will only
attempt suicide when they possess both dimensions explained in the model: the desire
to die and the ability to kill themselves. Rob's narrative aligns with this framework, as he
articulates the inability to find joy in his daily life, the feeling of being a burden to others,
and that nothing matters anymore. These sentiments underscore his desire to die,
reflecting defeat, despair, and a belief that his circumstances will not improve.
Joiner's IPT states that the ability to act on suicidal thoughts involves a sense of
guilt and a lack of belonging. Rob explicitly expresses feeling burdensome and unable to
rely on any support system except for his job. His belief that nobody needs him
intensifies his perceived isolation, creating a potent combination of factors contributing
to his capability to contemplate self-harm.
However, his description does not align with the ability to act on the desire to die
and commit suicide, given that in the end, he admits he would not want to die and that
the only thing he wishes is peace of mind.
Additionally, Joiner asserts that suicidal ideation is more likely to manifest in
someone who perceives themselves as a burden to others and who lacks a sense of
belonging within their social network. Rob’s relationship issues and his reluctance to
share his struggles with others reflect the interpersonal aspects of suicide ideation, as
the significance of social connections in mitigating suicidal tendencies is strongly
highlighted.
Rob's case is consistent with Joiner's IPT, illustrating the complex relationship
between the desire to die and the capability to carry out those impulses. Addressing his
feelings of isolation, building social connections, and providing support are essential
components in reducing the overall risk of suicide.
wordcount: 311
O’Connor’s integrated motivational-volitional (IMV) model
According to O'Connor's Integrated Motivational-Volitional (IMV) model,
developed on the basis of Ajzen’s theory of planned behavior, suicidal behavior results
from three distinct phases: the pre-motivational phase, the motivational phase, and the
volitional phase.
The pre-motivational phase, which precedes motivation, refers to the individual’s
background, childhood, environment, and genetic influences, and gives context for the
rise of suicidal thoughts. In Rob's case, this phase is marked by relationship issues, a
lack of fulfillment in his daily life, and an overarching feeling that life has been difficult
for an extended period. O'Connor suggests that these factors set the stage for the
development of suicidal thoughts.
 Under the motivational phase, we understand the main motivation that lies
behind the desire to kill oneself. Rob's sense of defeat, believing that things will never
get better, and feeling like a burden emerge as motivating factors for his suicidal
ideation. These feelings and the thought that nothing will be better after things have
been bad for a long time create a sense of entrapment, which also plays a key role in the
motivational phase of suicidal ideation. The lack of protective factors, such as healthy
coping mechanisms, social skills, a sense of belonging, or a strong support network,
intensifies his vulnerability during his phase.
His social problems and feelings of entrapment are Threat to Self Moderators
(TSM), which increase the individual’s perceived threat in their experiences in the
motivational phase. Motivational Motivators (MM) encompass factors like his lack of
belonging and feeling like a burden, which motivate an individual toward suicidal
behaviors.
Finally, the volitional phase involves all triggers that push a person to act upon
their thoughts. Rob's admission that he doesn't want to die but only wishes for peace of
mind highlights the internal conflict within this phase and is the reason that he has not
yet committed suicide. Fearlessness about death, impulsiveness, and access to means,
like guns, are factors that belong to the Volitional Motivators, which influence and
increase the potential for self-harm.
Rob's case highlights the importance of addressing the underlying motivational
and pre-motivational factors instead of just the immediate triggers. Developing
protective factors and promoting healthy coping mechanisms are crucial steps in
reducing the risk of suicide.
Word count: 373

STEP 2 – Self Care

In light of the possibility that after such a conversation the likelihood of
discussing topics like suicidal ideation increases, it is important to gain knowledge about
how to guide the conversation and be able to refer a person to the proper hotlines and
mental health services to get appropriate help.
You must not take responsibility for this person’s mental health. It is important
to not try to act as a mental health specialist yourself or try to give advice immediately,
the person only needs you to listen and acknowledge their feelings, so respect your
boundaries to protect your well-being.
Confidence and trust are important when somebody confesses such deep feelings
as suicidal ideation, but the severity of each individual case must be taken into account
when asked for secrecy, given that if the person is in immediate danger, their life and
safety are more important than keeping a secret.
It’s important to take care of oneself as well after talking to a person with suicidal
ideation given that it can affect you as well. You can talk to somebody about how you feel
after this, like a psychologist or a friend or family member you can trust.
Word count: 197
STEP 3 – Routine Outcome Monitoring (SQ-48)
Practice (intake)
Somatic complaints:
- Do you notice that your physical and emotional complaints began at the same time, or
close in time?
- Do you attach your physical complaints to sleeping problems?
- Do you have any medical history related to the pains that could explain them?
Depression:
- Do you notice any changes in your sleeping and/or eating habits?
- Do you feel any significant mood changes?
- Have you lost interest in activities you used to enjoy?
Cognitive complaints:
- Do you notice a change in your concentration or attention span?
- Do you ruminate about bad or negative thoughts that clash with your focus on other
tasks?
- Do you find it harder to perform tasks that used to be easy or simple?
Anxiety:
- Do you have excessively worrying thoughts more often?
- Do you relate your anxiety to something specific, like social situations or something you
are afraid of, and started avoiding it?
Hostility:
- Do you express your anger physically more than before?
- Do you get more easily irritated by things you didn’t before?

Step 4 – Routine Outcome Monitoring (OQ-45)

Practice (evaluation)
Even though both tests are self-report evaluation forms to assess a patient’s well-being
and screen for specific disorders, the SQ-48 is used to measure general psychopathologies, while
the OQ-45 measures more specific domains, namely symptomatic distress, interpersonal
relations anxiety and somatic distress, and social role. In addition, it measures treatment
outcomes and the patient’s well-being change during the treatment.
It is noticeable that the scores of all 4 domains of the OQ-45 were clinical at the
beginning of the treatment. These results are in accordance with the SQ-48 results, given that
the social role could be involved in the clinical results of anxiety and hostility as well.
Interpersonal relations also score on a clinical level, similar to the social role. Going from the
hypothesis that the anxiety probably stems from a social issue, it makes sense to link the 4
results and attach them to the same common problem.
Given these outcomes, the most important focus points of the therapy should be treating
a possible anxiety disorder with a likelihood of underlying social anxiety disorder or lack of
social skills, in addition to somatic complaints. These somatic complaints could be originated in
the anxiety disorder, which is something to look into, to discard the possibility of a
psychosomatic disorder.
The results show an improvement in all 4 categories from sessions 5 to 6. The general
change score is -34, and in total, no scores fall into clinical level anymore, except for
interpersonal relations. This could hint that the improvement of the patient is related to
targeting the initial anxiety issue and the related somatic symptoms, but it still is difficult to face
social situations and interpersonal relations with people, given the clinical results for hostility in
the SQ-48.
In conclusion, one could say the treatment was overall “successful”, because 3 out of the
4 domains that were clinical are not anymore. Maybe the score for interpersonal relations can
improve after more therapy sessions. But comparing the results for depression of the SQ-48 and
the remaining interpersonal relations, one would have to consider that maybe the anxiety is
being treated but it is the depression that is keeping the person from having average
interpersonal relations and not a social issue. It is also important to target the reason behind the
social and anxiety problems, because if they co-occur, there might be a history of bullying, for
example, that causes both depression and anxiety.
It is important to get a clear picture of a patient’s past to find underlying reasons for
certain behaviors or fears, and not assume from one test’s results that the reason behind all
problems is the same. Maybe the score for interpersonal relations can improve after more
therapy sessions.
Word count: 459