The role of intense affective states in signaling a suicide crisis

We explore the extent to which intense affective states in depressed patients may signal a suicide crisis, i.e., an acute risk for suicide. Therapists for 36 patients who died by suicide while in treatment completed questionnaires and wrote detailed structured narratives. Nine affects--desperation, hopelessness, rage, anxiety, feelings of abandonment, loneliness, guilt, humiliation, and self-hatred were evaluated as to their intensity in the patient before the suicide. Comparable information was obtained on 26 depressed, nonsuicidal patients treated by the same therapists. The suicide patients had a significantly greater number of intense affects than did the comparison patients. The affect that most distinguished the 2 groups was desperation, which was intense in 30 (83%) of the suicide patients but in none of the comparison patients. Recognizing intense affective states and the interaction among them may help clinicians identify a suicide crisis in depressed patients.