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Cited by 53Suicide and Self-Harm StudiesPsychiatric care and mental health servicesPersonality Disorders and Psychopathology

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

Open access
Jobes, David A., Chalker, Samantha A.·2019·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph16193606PMC PMC6801408
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Abstract

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, a “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical care of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper argues that a one-size-fits-all approach to suicidal risk—brief hospitalization and medication-only treatment of mental disorders—is not supported by evidence and should be replaced by suicide-focused, matched care. It reviews evidence-based interventions (DBT, CT-SP, BCBT, CAMS, stabilization/caring contacts) and proposes a stepped care public health model that is cost-effective, least-restrictive, and evidence-based.

Key findings

  • The authors state that three meta-analyses show treating mental disorders has little to no impact on suicidal ideation and behavior, and that evidence for inpatient care or medication-only approaches for suicidal risk is limited or lacking.
  • Among replicated suicide-focused treatments: CT-SP patients were 50% less likely to attempt suicide than usual care at 18 months; BCBT participants were 60% less likely to attempt suicide than treatment as usual over 24 months; CAMS significantly reduced suicidal ideation and overall psychiatric distress and increased hope and retention to care, and in one RCT CAMS did as well as DBT in reducing suicide attempts and self-harm.
  • Crisis Response Planning reduced suicide attempts by 76% at six-month follow-up compared with no-harm contracts; caring contacts via text messages were associated with less likelihood of any suicidal ideation and fewer attempts from baseline to 12 months, though severity of ideation and number of suicide risk incidents did not differ significantly.
  • Most suicidal people do not seek mental health care: only 19% sought care in the month before death, 32% in the year before suicide, and 38.5% of suicide decedents were engaged in mental health care within two months of death; in the U.S., 10,600,000 adults experience serious suicidal thoughts.

Methods

  • Design: narrative/conceptual review and policy commentary; no new empirical study or primary data collection.
  • Data/sample: cites existing literature, including over 80 RCTs with suicide-related outcomes, meta-analyses, national survey data, and clinical trials; no primary sample is analyzed.
  • Main analysis: narrative synthesis of evidence and proposal of a stepped care public health model; no systematic review or meta-analytic methods are stated.

Limitations

  • The paper states no formal limitations.
  • Evident from the text: it is a narrative/opinion review without a systematic search or appraisal strategy, and its treatment review is selective, focusing on replicated RCT-supported interventions; the referenced Figures 1 and 2 are not included in the provided text.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph16193606

Cites

65 of 65 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 85 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Ketamine's emergent use on suicidal ideation has short-lived effects for some suicidal patients.

    “the emergent use of ketamine on suicidal ideation for a few days [14] has short-lived effects for some suicidal patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Murrough, 2015, Ketamine for rapid reduction of suicidal ideation: A randomized controlled trial, Psychol. Med. source

      Not checked in the free run.

  • Premisecitation

    Treating mental disorders has little to no impact on suicidal ideation and behavior, according to three meta-analyses.

    “there is extensive evidence that targeting and treating mental disorders has little or mixed impact on suicidal risk [10,11,12].”
    • Also stated in: § 2.1. Psychopharmacology for Suicidal Risk · plain
      “Notably, there are now three meta-analyses showing that treating mental disorders has little to no impact on suicidal ideation and behavior [10,11,12].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Braun, 2016, Suicides and suicide attempts during long-term treatment with antidepressants: A meta-analysis of 29 placebo-controlled studies including 6934 patients with major depressive disorder, PPS

      Not checked in the free run.

    • cites [11] Cuijpers, 2013, The effects of psychotherapy for adult depression on suicidality and hopelessness: A systematic review and meta-analysis, J. Affect. Disord. source

      Not checked in the free run.

    • cites [12] Jakobsen, J.C., Katakam, K.K., Schou, A., Hellmuth, S.G., Stallknecht, S.E., Leth-Møller, K., Iversen, M., Banke, M.B., Petersen, I.J., and Klingenberg, S.L. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry, 17. source

      Not checked in the free run.

  • Interpretationcitation

    Insisting on the pre-eminence of treating mental disorders (particularly using only medicine) for suicidal risk defies the extensive evidence-base that supports the effectiveness of targeting and treating suicidal ideation and behaviors independently of psychiatric diagnoses.

    “insisting on the pre-eminence of treating mental disorders (particularly using only medicine) for suicidal risk defies the extensive evidence-base that supports the effectiveness of targeting and treating suicidal ideation and behaviors independently of psychiatric diagnoses (refer to [19]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Jobes, 2015, Psychological approaches to suicide treatment and prevention, Curr. Treat. Options Psychiatry source

      Not checked in the free run.

  • Interpretationreasoning

    Such issues and fears may lead to overly defensive practices (e.g., hospitalizing a patient who has passive suicidal thoughts).

    “In turn, such issues and fears may lead to overly defensive practices (e.g., hospitalizing a patient who has passive suicidal thoughts).”
    Quote in the paperSubstantial claim
  • Premisecitation

    One un-replicated RCT has shown that clozapine can reduce suicidal ideation and attempts among thought-disordered patients.

    “one un-replicated RCT has shown that clozapine can reduce suicidal ideation and attempts among thought-disordered patients [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Meltzer, 2003, Clozapine treatment for suicidality in schizophrenia: International suicide prevention trial (InterSePT), Arch. Gen. Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 19
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Some clinicians may find themselves not always working in the patient's best interest due to countertransference issues or fear of litigation should a patient take their life.

    “some clinicians may find themselves not always working in the patient’s best interest due to countertransference issues or fear of litigation should a patient take their life.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking.

    “Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [10] Braun, 2016, Suicides and suicide attempts during long-term treatment with antidepressants: A meta-analysis of 29 placebo-controlled studies including 6934 patients with major depressive disorder, PPS

      Not checked in the free run.

    • cites [11] Cuijpers, 2013, The effects of psychotherapy for adult depression on suicidality and hopelessness: A systematic review and meta-analysis, J. Affect. Disord. source

      Not checked in the free run.

    • cites [12] Jakobsen, J.C., Katakam, K.K., Schou, A., Hellmuth, S.G., Stallknecht, S.E., Leth-Møller, K., Iversen, M., Banke, M.B., Petersen, I.J., and Klingenberg, S.L. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry, 17. source

      Not checked in the free run.

    • cites [13] Zalsman, 2016, Suicide prevention strategies revisited: 10-year systematic review, Lancet Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Safety Plan Intervention (SPI) is superior to no-harm contracting for reducing suicide attempt behaviors, as demonstrated in a large cohort-comparison study of suicidal U.S. military veterans.

    “the superiority of the SPI over no-harm contracting for reducing suicide attempt behaviors was clearly demonstrated [24] in a large cohort-comparison study of suicidal U.S. military veterans”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Stanley, 2018, Comparison of the Safety Planning Intervention with Follow-up vs. Usual Care of Suicidal Patients Treated in the Emergency Department, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Such practice behaviors may be shaped by wishful thinking that a three to six-day hospital stay or treating the mental disorder with medicine is actually more effective for suicidal risk than alternative approaches that are supported by the data.

    “Moreover, such practice behaviors may be shaped by wishful thinking that a three to six-day hospital stay or that treating the mental disorder with medicine is actually more effective for suicidal risk than alternative approaches that are supported by the data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Some contemporary providers may make assumptions about the presumed effectiveness of inpatient care and the use of medicine on suicidal risk.

    “Jobes has argued that some contemporary providers may make assumptions about the presumed effectiveness of inpatient care and the use of medicine on suicidal risk [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Jobes, 2017, Clinical assessment and treatment of suicidal risk: A critique of contemporary care and CAMS as a possible remedy, Pract. Innov. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Dweck's empirical work has shown the existence of two distinct mindsets: a "fixed" mindset versus a "growth" mindset.

    “Dweck’s empirical work has shown the existence of two distinct mindsets: a “fixed” mindset versus a “growth” mindset.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Dweck, C. (2012). Mindset: Changing the Way You Think to Fulfil Your Potential, Hachette UK.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Such presumptions can have a major impact on the patient's clinical disposition, and even the course of their entire life.

    “Importantly, such presumptions can have a major impact on the patient’s clinical disposition, and even the course of their entire life.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Dweck's research shows these mindsets are reliably associated with different outcomes for personal and professional success, and a growth mindset is much more adaptive and linked to successful outcomes.

    “Her research shows how these mindsets are reliably associated with different outcomes for personal and professional success, and a growth mindset is much more adaptive and linked to successful outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Dweck, C. (2012). Mindset: Changing the Way You Think to Fulfil Your Potential, Hachette UK.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prominent experts insist on the primacy of treating mental disorders to reduce suicidal risk, even trivializing the effectiveness of suicide-focused psychological treatments that have been proven by replicated RCT data.

    “prominent experts (e.g., [17]) insist on the primacy of treating mental disorders to reduce suicidal risk, even trivializing the effectiveness of suicide-focused psychological treatments that have been proven to work by replicated data from rigorous randomized controlled trials.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Hoge, 2019, Suicide reduction and research efforts in service members and veterans—Sobering realities, JAMA Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bryan and colleagues performed an RCT comparing the Crisis Response Plan (CRP) to no-harm contracts and showed a significant effect on both suicidal ideation and suicide attempts, reducing the latter by 76% at six-month follow-up.

    “Bryan and colleagues [28] performed a convincing RCT comparing the CRP to no-harm contracts and showed a significant effect on both suicidal ideation and suicide attempts, reducing the latter by 76% at the six-month follow-up assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Bryan, 2017, Effect of crisis response planning vs. contracts for safety on suicide risk in US Army Soldiers: A randomized clinical trial, J. Affect. Disord. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    There may be a misguided notion that a "one-size" approach (i.e., a brief hospitalization and medication to treat the disorder) will work for all suicidal patients.

    “Thus, there may be a misguided notion that a “one-size” approach (i.e., a brief hospitalization and medication to treat the disorder) will work for all suicidal patients [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Jobes, D.A. (2019, January 24–27). One size does not fit all: Matching empirically proven interventions to different suicidal states. Proceedings of the American Association of Suicidology, Denver, CO, USA.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cognitive Therapy for Suicide Prevention (CT-SP) is an effective treatment that targets the 'suicidal mode'.

    “Another effective treatment that targets the “suicidal mode” is Cognitive Therapy for Suicide Prevention (CT-SP) [71].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Brown, 2005, Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    There is no policy initiative in the history of suicide prevention that has been more influential and impactful than Zero Suicide.

    “It is fair to say there is no policy initiative in the history of suicide prevention that has been more influential and impactful than Zero Suicide (see discussion by [38]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Hogan, 2016, Suicide prevention: An emerging priority for health care, Health Aff. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisereasoning

    RCTs are the gold standard of what has proven effective in a causal manner because of their reliance on experimental designs and a-priori hypothesis testing.

    “Within clinical science, RCTs are the gold standard of what has proven effective in a causal manner because of their reliance on experimental designs and a-priori hypothesis testing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Major barriers for suicidal individuals to seek mental health care include low perceived need, attitudes to treatment, and practical concerns.

    “The major barriers for suicidal individuals to seek mental health care include low perceived need, attitudes to treatment (e.g., the wish to handle it on one’s own), and practical concerns (e.g., financial concerns).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Bruffaerts, 2011, Treatment of suicidal people around the world, Br. J. Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent RCT with suicidal military personnel found that those receiving caring contacts via text message were less likely to have any suicidal ideation and fewer attempts from baseline to 12 months.

    “The investigators found that those receiving caring contacts via text message were less likely to have any suicidal ideation and fewer attempts from baseline to 12 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Comtois, 2019, Effect of augmenting standard care for military personnel with brief caring text messages for suicide prevention: A randomized clinical trial, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    SAMHSA's "Recommended Standard Care for People with Suicide Risk" recommends basic approaches: identification/assessment of risk, stabilization/safety planning, lethal means safety discussions, the National Suicide Prevention Lifeline, and caring contact follow-up.

    “The “Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe” document [53] recommends basic approaches to working with suicidal patients, primarily emphasizing: identification/assessment of risk, stabilization/safety planning, lethal means safety discussions, the National Suicide Prevention Lifeline, and caring contact follow-up”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] National Suicide Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group (2018). Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe, Education Development Center, Inc.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A survey on how suicidal individuals cope with suicidal thoughts showed overwhelmingly that talking with someone who was not a mental health professional was the primary response; only 12% included talking to someone in the mental health profession.

    “A survey on how suicidal individuals cope with their suicidal thoughts showed overwhelmingly that talking with someone who was not a mental health professional was the primary response. Only 12% of respondents included talking to someone in the mental health profession [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Alexander, 2009, Coping with thoughts of suicide: Techniques used by consumers of mental health services, Psychiatr. Serv. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cognitive therapy techniques have proven successful for treating an extensive array of psychiatric disorders.

    “which have proven successful for treating an extensive array of psychiatric disorders [73]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Beck, 2005, The current state of cognitive therapy: A 40-year retrospective, Arch. Gen. Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alexander and colleagues have advocated for education and support for family and peers as another line of intervention for loved ones in crisis.

    “Alexander and colleagues [41] have advocated for education and support for family and peers as another line of intervention for loved ones in crisis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Alexander, 2009, Coping with thoughts of suicide: Techniques used by consumers of mental health services, Psychiatr. Serv. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Zero Suicide policies are embraced across the United States and now around the world.

    “Zero Suicide policies are embraced across the United States and now around the world.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Hogan, 2016, Suicide prevention: An emerging priority for health care, Health Aff. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The goals of precision medicine are to understand how the effects of treatment are modified by patient characteristics and to develop precision treatment rules (PTRs) to determine which treatments are likely to yield the best outcome for each patient or fine-grained patient subgroup.

    “As described by Kessler, et al. [61], the goals of “precision medicine” are to understand how the effects of treatment are modified by patient characteristics and to develop “precision treatment rules” (PTRs) based on this understanding to determine which of the treatments under consideration is likely to yield the best outcome for each patient or fine-grained patient subgroup.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Kessler, R.C., Chalker, S.A., Luedtke, A.R., Sadikova, E., and Jobes, D.A. (2019). A preliminary precision treatment rule for collaborative assessment and management of suicidality relative to enhanced care-as-usual in prompting rapid remission of suicide ideation. Behav. Res. Ther. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisereasoning

    RCTs that have replicated results, particularly when replicated by independent investigators, rise to the top of the list when considering empirically validated interventions.

    “RCTs that have replicated results, particularly when results have been replicated by independent investigators rise to the top of the list when we consider empirically validated interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    While DBT has shown impressive results in managing suicidal behaviors, it is not solely devoted to treating suicidality, and replicated results for reliably decreasing suicidal ideation are not consistent across all DBT RCTs.

    “while DBT has shown impressive results in managing suicidal behaviors [70], it is not solely devoted to treating suicidality, and replicated results for reliably decreasing suicidal ideation are not consistent across all DBT RCTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] DeCou, 2019, Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis, Behav. Ther. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Galynker and colleagues have proposed the "Suicide Crisis Syndrome."

    “Galynker and colleagues [59] have proposed the “Suicide Crisis Syndrome.””
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Galynker, 2017, Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory, Depress. Anxiety source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the same RCT, the likelihood or severity of suicidal ideation and the number of suicide risk incidents were not significantly different between groups.

    “However, the likelihood or severity of suicidal ideation and the number of suicide risk incidents (i.e., hospitalization or medical evacuation) were not significantly different between groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Comtois, 2019, Effect of augmenting standard care for military personnel with brief caring text messages for suicide prevention: A randomized clinical trial, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Joiner and colleagues have proposed a potential DSM-6 candidate diagnosis called "Acute Suicidal Affective Disturbance."

    “Joiner and colleagues have proposed a potential DSM-6 candidate diagnosis called “Acute Suicidal Affective Disturbance” [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Stanley, 2016, Acute suicidal affective disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients, J. Psychiatr. Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    More recent results have demonstrated DBT's continued impact on decreasing suicidal behaviors among high risk individuals such as those with borderline personality disorder, and decreasing suicide ideation and self-harm among adolescents.

    “More recent results have demonstrated DBT’s continued impact on decreasing suicidal behaviors among high risk individuals such as those with borderline personality disorder [67], and decreasing suicide ideation [68] and self-harm [69] among adolescents.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [67] Linehan, 2015, Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis, JAMA Psychiatry source

      Not checked in the free run.

    • cites [68] Goldstein, 2015, Dialectical behavior therapy for adolescents with bipolar disorder: Results from a pilot randomized trial, J. Child Adole. Psychopharm. source

      Not checked in the free run.

    • cites [69] Mehlum, 2016, Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: Outcomes over a one-year follow-up, J. Am. Acad. Child Adole. Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Jobes argued for the pursuit of "prescriptive" treatments, that is, matching different interventions to different suicidal states.

    “Jobes argued many years ago for the pursuit of “prescriptive” treatments, that is, matching different interventions to different suicidal states [60].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [60] Jobes, 1995, The challenge and the promise of clinical suicidology, Suicide Life Threat. Behav. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    CAMS does not require clinicians to give up their theoretical orientation or abandon reliable techniques.

    “As a framework, not a new psychotherapy, the CAMS intervention does not require clinicians to give up their theoretical orientation or abandon reliable techniques.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Jobes, D.A. (2006). Managing Suicidal Risk: A Collaborative Approach, Guilford Press.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CAMS is a distinctive therapeutic framework that targets suicidality.

    “Jobes describes the Collaborative Assessment and Management of Suicidality (CAMS) as a distinctive therapeutic framework that targets suicidality [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Jobes, D.A. (2016). Managing Suicidal Risk: Second Edition: A Collaborative Approach, Guilford Press. [2nd ed.].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CAMS is a 'non-denominational' approach where potentially any treatment can be used within the framework.

    “Indeed, CAMS is a “non-denominational” approach where potentially any treatment can be used within the framework [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Jobes, D.A. (2006). Managing Suicidal Risk: A Collaborative Approach, Guilford Press.

      Not checked in the free run.

32 of 32

  • The paper relies on this without support.

    Healthcare costs are probably the single biggest force shaping healthcare practices in the real world.

    “The healthcare costs, represented on the y-axis, are probably the single biggest force shaping healthcare practices in the real world.”

  • The paper relies on this without support.

    There will never be enough clinical providers to meet the needs of 10.6 million adults with serious suicidal thoughts in the United States.

    “There will never be enough clinical providers to meet the needs of 10.6 million adults with serious suicidal thoughts (in the United States example).”

  • The paper relies on this without support.

    The National Lifeline is currently facing significant capacity issues.

    “which is currently facing significant capacity issues.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Evidence-based models of suicide prevention are based on an acknowledgement of the importance of a collaborative alliance between service users and professionals.

    “Evidence-based models of suicide prevention are based on an acknowledgement of the importance of a collaborative alliance between service users and professionals [4, 5].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [5]

    Section 6.4 describes CAMS as a collaborative, evidence-supported treatment, and §4.1 contrasts patient-guided safety planning with coercive contracts. These passages support the importance of collaboration in particular approaches, but the paper does not say that a collaborative service-user–professional alliance underpins evidence-based suicide-prevention models generally. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The notion that one size does not fit all seems to emerge from these preliminary RCT findings.

    “In other words, the notion “one size does not fit all” seems to emerge from these preliminary RCT findings [refer to (60)].”

    From The use of CAMS and DBT to effectively treat patients who are suicidal (2024) · cites this paper as [60]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • BCBT is presented as replicated despite only one cited RCT

    Minor

    BCBT is one of the four featured treatments said to have replicated results and independent RCT support, yet its section describes evidence from one RCT.

1 of 1

Cites

Flagged first, then by citations

1 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Jobes, D.A. (2019, January 24–27). One size does not fit all: Matching empirically proven interventions to different suicidal states. Proceedings of the American Association of Suicidology, Denver, CO, USA.
  2. Rudd, M.D., Joiner, T.E., and Rajab, M.H. (2004). Treating Suicidal Behavior: An Effective, Time-Limited Approach, Guilford Press.
  3. Jobes, D.A. (2016). Managing Suicidal Risk: Second Edition: A Collaborative Approach, Guilford Press. [2nd ed.].
  4. Au, J.S. (2019). Typologies of Suicidal Patients Based on Suicide Status Form Data. [Ph.D. Thesis, The Catholic University of America].
  5. Linehan, M. (1993). Cognitive-Behavioral Treatment for Borderline Personality Disorder, Guilford Press.

Cited by

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Related

Authors
Jobes, D. A., & Chalker, S. A.
Affiliations
Catholic University of America (US)
Corresponding author
Jobes, David A.
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2019-09-26
Volume
16
Issue
19
Pages
3606
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph16193606
PMC
PMC6801408
OpenAlex
W2976096520
Semantic Scholar
0006a3f6b340119b8e5f0b44ec5508de9ca49a88
Cited by
52
References
66
Citations by year
2026: 3 · 2025: 11 · 2024: 4 · 2023: 10 · 2022: 13 · 2021: 5 · 2020: 6
FWCI
0.95
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
suicidal ideation, suicide attempts, suicide prevention, suicide risk, hospitalization, psychotropic drugs, stepped care, public health model, mental illness, history of psychiatry, least restrictive alternative
MeSH terms
Adult, Female, Humans, Male, Mental Health Services, Suicide, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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