Warning signs for suicide: theory, research, and clinical applications
Abstract
The current article addresses the issue of warning signs for suicide, attempting to differentiate the construct from risk factors. In accordance with the characteristic features discussed, a consensus set of warning signs identified by the American Association of Suicidology working group are presented, along with a discussion of relevant clinical and research applications.
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Changes in symptoms over time, especially drastic changes over short periods of time (within days or hours), may provide a better indication of risk than absolute ratings at any single time point.
“Changes in symptoms over time, especially drastic changes over short periods of time (within days, hours), may provide a better indication of risk than absolute ratings at any single time point (35).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [35]
Cites
Editorial Office (1997) · Obesity Surgery · doi:10.1381/096089297765555359 · Cited by 3,917 · see citing works
Joiner, T. E. (2007) · Harvard University Press eBooks · doi:10.2307/j.ctvjghv2f · Cited by 2,891 · see citing works
Self-citationRisk factors for suicide in psychiatric outpatients: A 20-year prospective study.
Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.3.371 · Cited by 1,317 · see citing works
Youth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000046821.95464.cf · Cited by 1,264 · see citing works
Clinical correlates of inpatient suicide
Busch, K. A., Fawcett, J., & Jacobs, D. G. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0105 · Cited by 750 · see citing works
Knecht, A. A. (1972) · JONA The Journal of Nursing Administration · doi:10.1097/00005110-197203000-00014 · Cited by 627 · see citing works
Evaluating Iatrogenic Risk of Youth Suicide Screening Programs: A Randomized Controlled Trial
Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005) · JAMA · doi:10.1001/jama.293.13.1635 · Cited by 522 · see citing works
Achieving the promise: Transforming mental health care in America
The President's New Freedom Commission on Mental Health (2007) · PsycEXTRA Dataset · doi:10.1037/e432262008-003 · Cited by 496 · see citing works
(2001) · Cited by 150 · see citing works
American Association of Suicidology
Danto, B. L. (1974) · Clinical Toxicology · doi:10.3109/15563657408988036 · Cited by 134 · see citing works
Joiner, T., Kalafat, J., Draper, J., Stokes, H., Knudson, M., Berman, A. L., & McKeon, R. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.353 · Cited by 118 · see citing works
Self-citationRecognizing and Responding to a Suicide Crisis
Hendin, H., Maltsberger, J. T., Lipschitz, A., Haas, A. P., & Kyle, J. E. (2001) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.31.2.115.21515 · Cited by 81 · see citing works
LETTER TO THE EDITOR: Warning Signs for Suicide?
Rudd, M. D. (2003) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.33.1.99.22790 · Cited by 51 · see citing works
Self-citationScreening for suicide risk in the pediatric emergency and acute care setting
Wintersteen, M. B., Diamond, G. S., & Fein, J. A. (2007) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e328220e997 · Cited by 50 · see citing works
Goodwin, F. K. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0104 · Cited by 49 · see citing works
Determination of Precipitating Events in the Suicide of Psychiatric Patients
Maltsberger, J. T., Hendin, H., Haas, A. P., & Lipschitz, A. (2003) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.33.2.111.22778 · Cited by 47 · see citing works
Warning Signs for Suicide on the Internet: A Descriptive Study
Mandrusiak, M., Rudd, M. D., Joiner, T. E., Berman, A. L., Orden, K. A. V., & Witte, T. K. (2006) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2006.36.3.263 · Cited by 46 · see citing works
Self-citationA Test of the Effectiveness of a List of Suicide Warning Signs for the Public
Orden, K. A. V., Joiner, T. E., Hollar, D. L., Rudd, M. D., Mandrusiak, M., & Silverman, M. M. (2006) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2006.36.3.272 · Cited by 43 · see citing works
Self-citationAnnual Progress in Child Psychiatry and Child Development 1988
McDermott, J. F. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.6.808 · Cited by 41 · see citing works
Evaluation of a youth suicide prevention school program.
Nelson, F. L. (1987) · PubMed · Cited by 38 · see citing works
The 24 Hours before Hospitalization: Factors Related to Suicide Attempting
Chiles, J. A., Strosahl, K. D., Cowden, L., Graham, R. A., & Linehan, M. M. (1986) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1986.tb01015.x · Cited by 20 · see citing works
Helping to curb youth violence: The APA-MTV "Warning Signs" initiative.
Peterson, J. L., & Newman, R. (2000) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.31.5.509 · Cited by 17 · see citing works
Treating Suicidal Behavior: An Effective, Time-Limited Approach.
Schwartz, R. C. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200109000-00017 · Cited by 16 · see citing works
Psychobiology and psychopharmacology
Flach, F. F. (1988) · Norton eBooks · Cited by 15 · see citing works
Goodwin, F. K. (2003) · PubMed · Cited by 6 · see citing works
(2011) · PsycEXTRA Dataset · doi:10.1037/e520162011-001 · Cited by 2 · see citing works
Hosansky, D. (2004) · CQ Press eBooks · doi:10.4135/cqresrre20040213 · Cited by 1 · see citing works
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Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017) · Psychological Bulletin · doi:10.1037/bul0000084 · Cited by 3,784 · see citing works
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Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S. L., & Spirito, A. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.1.92 · Cited by 435 · see citing works
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Walsh, C. G., Ribeiro, J. D., & Franklin, J. C. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12916 · Cited by 264 · see citing works
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Fowler, J. C. (2012) · Psychotherapy · doi:10.1037/a0026148 · Cited by 222 · see citing works
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DeJong, T. M., Overholser, J. C., & Stockmeier, C. A. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.10.020 · Cited by 198 · see citing works
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Yazdavar, A. H., Mahdavinejad, M. S., Bajaj, G., Romine, W., Sheth, A., Monadjemi, A. H., Thirunarayan, K., Meddar, J. M., Myers, A., Pathak, J., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0226248 · Cited by 133 · see citing works
Czyz, E. K., Horwitz, A. G., Arango, A., & King, C. A. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12974 · Cited by 130 · see citing works
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Hendin, H., Maltsberger, J. T., & Szanto, K. (2007) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e318052264d · Cited by 121 · see citing works
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Miller, A. B., Eisenlohr-Moul, T., Giletta, M., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000210 · Cited by 81 · see citing works
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Bloch-Elkouby, S., Barzilay, S., Gorman, B. S., Lawrence, O. C., Rogers, M. L., Richards, J., Cohen, L. J., Johnson, B. N., & Galynker, I. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.048 · Cited by 72 · see citing works
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Ribeiro, J. D., Yen, S., Joiner, T., & Siegler, I. C. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.07.037 · Cited by 48 · see citing works
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- Authors
- Rudd, M. D., Berman, A. L., Joiner, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., Van Orden, K., & Witte, T.
- Affiliations
- Texas Tech University (US)
- Florida State University (US)
- Harvard University (US)
- University of Chicago (US)
- Baylor University (US)
- Corresponding author
- Rudd, M. David
- Venue
- Suicide and Life-Threatening Behavior
- Publisher
- Wiley
- Published
- 2006-06
- Volume
- 36
- Issue
- 3
- Pages
- 255-262
- ISSN
- 0363-0234 (ISSN-L)
- 1943-278X
- OpenAlex
- W2058538916
- Cited by
- 548
- References
- 27
- Citations by year
- 2026: 24 · 2025: 24 · 2024: 32 · 2023: 21 · 2022: 31 · 2021: 51 · 2020: 29 · 2019: 30 · 2018: 31 · 2017: 41 · 2016: 30 · 2015: 43 · 2014: 35 · 2013: 34 · 2012: 20
- FWCI
- 14.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Suicide and Life-Threatening Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide warning signs, suicide risk factors, suicide prevention, suicide assessment, clinical application
- MeSH terms
- Expert Testimony, Humans, Psychological Theory, Suicide, Attempted
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