The American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management

This third edition offers updates on many topics and new chapters devoted to sleep and suicide risk, neuromodulation treatments, and teaching psychiatry residents about suicide. It balances the most high-yield topics while giving attention to scenarios that need more research but are immediately clinically relevant. The community pharmacy and telehealth settings are newer areas for exploring suicide risk and management, which may be included in future editions. This is critical reading for all psychiatrists.

-- Daniel M Tuinstra, M.D. * Doody's Book Reviews *

Even as suicide rates have decreased globally in
recent years, and despite significant prevention
efforts, US suicide rates have risen 35% since
2000.1 Some predict that rates will increase still
further in the wake of the economic stress and
social isolation brought about by the coronavirus
disease 2019 (COVID-19) pandemic.2,3 Thus,
publication of the third edition of the American
Psychiatric Association Publishing Textbook of
Suicide Risk Assessment and Management is both
welcome and timely.
This edition's structure parallels that of the previous edition, including sections on risk assessment
and treatment, major disorders, treatment settings,
prevention, and special topics. Each chapter provides a useful conclusion paragraph and summary
bullet points. Notably, this volume is significantly
smaller than its predecessor (477 vs. 744 pages),
specifics of which are discussed below.
Considering recent failures to reduce the toll of
suicide in the United States, it is encouraging that
the scientific field of suicide studies has recently
begun to see much-needed change, with movement
from the traditional view of suicide as simply a
symptom of mental illness to newer models that
approach suicide as a transdiagnostic issue of primary clinical focus. In this framework, interventions
are designed specifically around the unique needs of
suicidal individuals, with similarities in suicidal
processes across diagnoses outweighing the differences. These processes include such transdiagnostic
vulnerabilities as cognitive rigidity, hopelessness,
deficient problem-solving, emotion dysregulation,
acquired capability, and sleep disturbance.4,5
The third edition of this textbook commendably
reflects this evolution, although not to the extent
that one might wish. For example, an excellent
chapter on depressive disorders contains a lengthy
section on transdiagnostic considerations, yet the
book continues with separate chapters on various
disorders, without much discussion of how suicidal
and nonsuicidal patients with the same diagnosis
differ in terms of treatment needs. A transdiagnostic approach, on the other hand, would help
explain why only a small percentage of people with
a given psychiatric disorder die by suicide and how
they differ from patients who do not.
The reduced size of the new edition is especially
noticeable in the area of risk assessment, where 5
chapters are reduced to only 1; largely missing is
guidance beyond what information one should
gather regarding risk factors and warning signs to
coverage of how to obtain valid information in such
a sensitive area. Few details are provided on systems such as the Chronologic Assessment of Suicide
Events (CASE) approach6 or The Collaborative
Assessment and Management of Suicidality
(CAMS) framework,7 both of which provide structured, evidence-based methods for addressing a
topic that most patients (and many clinicians)
would prefer to avoid. Similarly, treatment chapters
such as the one on cognitive-behavior therapy are quite brief and primarily descriptive, with little in
the way of "how-to's" to guide the clinician.
The presentation of information improves considerably in later portions of the book. For example,
the chapter on sleep and suicide not only presents
an overview of relevant theory and research but
also provides detailed discussions of the management of insomnia and nightmares. Likewise, the
chapter on firearms and suicide provides excellent
guidance for practitioners on navigating the challenging waters of reducing access to firearms by
people at risk for suicide.
The chapter, perhaps most likely to show the
reader that "times have changed" is the updated
chapter on social media and the internet. In it, we
see the 2-edged sword of the digital world, which
includes both potentially life-saving resources and
darker areas where bullying, taunting, and even
"digital self-harm" lurk. Included in this chapter is
a highly useful list of suggested clinical interview
questions and prompts regarding internet issues of
possible relevance to suicide risk.
Despite its reduced size, the new edition does add
chapters on topics that were not present in the
previous edition, including chapters on college and
university students, self-injurious behavior
(including nonsuicidal self-injury), and physicianassisted dying. The last of these commendably
considers whether the term "physician-assisted
suicide" should be retired in cases of terminally ill
individuals who typically do not wish to die but also
do not want themselves or their families to go
through a lingering, painful dying process. This
chapter includes an excellent overview of the status
of assisted dying laws across the United States and
internationally.
Overall, the American Psychiatric Association
Publishing Textbook of Suicide Risk Assessment
and Management, Third Edition, follows in the
footsteps of previous editions as a quality reference
volume. It is authoritative, digestible, and applicable to practice in multiple settings, whether
academic, correctional, inpatient, outpatient, or
emergency care. In areas where it is lacking in
detail, it provides the reader with ample ideas on
where one might obtain further information or
training. As such, it continues to be an important
resource in the libraries of practicing psychiatrists,
other mental health professionals, and professionals in training.

-- Thomas E. Ellis, PsyD, ABPP * Journal of Psychiatric Practi