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What Everyone Must Know about Suicide Crisis Syndrome

Suicide crisis syndrome (SCC) is an acute condition that marks an increased risk of suicidal behavior soon. Several studies show that SCC is a separate diagnosis entity with five main components. SSC components are entrapment, affective disturbance, loss of cognitive control, altered arousal, and social withdrawal.

WHO reports that suicide causes 800,000 deaths annually, equivalent to one death every 40 seconds. Suicide is the second leading cause of death in the 15-29 years age group.

Most patients who commit suicide experience mental disorders, especially depression, but not all patients with mental disorders commit suicide. Even in some patients who commit suicide, the diagnosis of mental disorder cannot be established. It raises the opinion that suicide behavior needs to get its diagnostic criteria.

What Everyone Must Know about Suicide Crisis Syndrome

Long-term risk factors for suicide have been identified, such as a history of mental illness and a history of attempted suicide. However, identifying the risk of suicide in the short term is difficult. Nevertheless, the fact is that suicidal ideation can only arise within 10 minutes before the individual takes action, which means that the idea of ​​suicide may appear outside the clinical setting.

Suicide crisis syndrome is a specific condition associated with imminent suicide behavior (threatening/imminent). This syndrome can be described as a pre-suicide mental condition that is assessed based on cognitive and affective dysregulation. This syndrome was first described by Yaseen et al. based on the results of the patient's assessment using the Suicide Trigger Scale (STS) instrument that can predict suicidal behavior.

Suicide Crisis Syndrome has five components, namely:

1. Entrapment
2. Affective disorders
3. Loss of cognitive control
4. Altered arousal
5. Social withdrawal

This syndrome is an acute condition that develops in a matter of hours to days before committing suicide.

Diagnostic Criteria for Suicide Crisis Syndrome

The diagnostic criteria for suicide crisis syndrome have been proposed and tested for validity. The diagnostic criteria for suicide crisis syndrome consist of 2 criteria, namely the criterion A is entrapment or frantic hopelessness, and the criterion B criterion is associated disturbances. 

Criterion A
Criterion A is characterized by persistent feelings of entrapment and despair. The feeling of being trapped is the feeling of wanting to get away from an unpleasant life situation, but discovering the fact that this life situation is impossible to avoid.

Criterion B
Criterion B consists of components of affective disorder, cognitive loss, altered arousal, and social withdrawal.

a. Affective Disorders:
Affective disorders can manifest into several different symptoms that sometimes overlap. These symptoms namely feelings of depression (depressive turmoil), anxiety accompanied by confusion (frantic anxiety), acute anhedonia, and emotional pain.

b. Loss of Cognitive Control:
Loss of cognitive control includes symptoms of rumination (contemplation), cognitive rigidity, thought suppression, and deeper reflection (ruminative flooding).

c. Altered Arousal:
Altered arousal, often in the form of overarousal or anxiety, is an acute risk factor for suicide. Overarousal symptoms can manifest as agitation, excessive alertness, irritability, and insomnia.

d. Social Withdrawal:
Social isolation is a strong predictor of suicide. Those who experience loneliness, both physically and psychologically, have a higher risk of suicide. Manifestations can include withdrawal or decline in social activities and avoid contact or communication with others.

Predictive Validity of the Criteria for Diagnosis of Suicide Crisis Syndrome

Yaseen et al. try to assess the predictive validity of the above diagnostic criteria. The study was conducted on 170 patients who were hospitalized due to suicidal thoughts and behavior. This study found that the use of criterion A alone had a sensitivity of 55.6% and specificity of 70.1%. The use of criterion B alone has a sensitivity of 55.6% and specificity of 81.6%. The use of both criteria together has a sensitivity of 44.4% and a specificity of 92.8%.

written by dr. Irwan Supriyanto Ph.D. Psychiatrist

1. Schuck A, Calati R, Barzilay S, Bloch‐Elkouby S, Galynker I. Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis. Behav Sci Law 2019;37:223–39. [https://onlinelibrary.wiley.com/doi/abs/10.1002/bsl.2397]
2. Galynker I. Suicide Crisis Syndrome. Oxford University Press; 2017 DOI: 10.1093/med/9780190260859.003.0007 [http://www.oxfordmedicine.com/view/10.1093/med/9780190260859.001.0001/med-9780190260859-chapter-7]
3. WHO. Mental Health: Suicide Data. https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
4. Cohen LJ, Ardalan F, Yaseen Z, Galynker I. Suicide Crisis Syndrome Mediates the Relationship Between Long-term Risk Factors and Lifetime Suicidal Phenomena. Suicide and Life-Threatening Behavior. 2017. DOI:10.1111/sltb.12387
5. Galynker I. Suicide Crisis Syndrome. Oxford University Press; 2017 DOI: 10.1093/med/9780190260859.003.0007 [http://www.oxfordmedicine.com/view/10.1093/med/9780190260859.001.0001/med-9780190260859-chapter-7]
6. Yaseen Z, Katz C, Johnson MS, Eisenberg D, Cohen LJ, Galynker II. Construct development: The Suicide Trigger Scale (STS-2), a measure of a hypothesized suicide trigger state. BMC Psychiatry 2010;10:110. [https://www.ncbi.nlm.nih.gov/pubmed/21144063]
7. Yaseen ZS, Hawes M, Barzilay S, Galynker I. Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide Life Threat Behav 2018; Available from http://doi.wiley.com/10.1111/sltb.12495 [https://www.ncbi.nlm.nih.gov/pubmed/30073686]

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