Academic journal article Journal of Mental Health Counseling

Executive Functioning as a Component of Suicide Risk Assessment: Clarifying Its Role in Standard Clinical Applications

Academic journal article Journal of Mental Health Counseling

Executive Functioning as a Component of Suicide Risk Assessment: Clarifying Its Role in Standard Clinical Applications

Article excerpt

Clinically, because executive dysfunction (e.g., impulsivity,, insight, thinking process) is often thought of in the context of those with traumatic brain injuries and other neurologic conditions, its formal assessment has historically been seen as the domain of those who assess and treat patients with neurologic disease. However, mental health counselors (MHCs) could benefit from learning how executive functioning relates to suicide risk assessment and coping strategies. Assessment of executive functions can be incorporated in routine clinical practice without the need for formal neuropsychological measures or other time-consuming procedures. In fact, during standard clinical assessment, mental health professionals often informally assess components of executive functioning such as impulsivity, insight, and thinking processes. This article highlights aspects of executive functioning with which MHCs may already be familiar and demonstrates their clinical utility in enhancing assessment and management of suicide-related thoughts and behaviors.

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Although executive dysfunction is often thought of in the context of such neurologic conditions as traumatic brain injury, mental health counselors (MHCs) could benefit from knowing how executive functioning relates to suicide risk assessment and coping strategies. Executive functioning refers to a set of higher-order mental activities primarily governed by' the frontal lobes (Lezak, Howieson, & Loring, 2004; McDonald, Flashman, & Saykin, 2002) including initiation, planning, and self-regulation of goal-directed behavior (Berger & Posner, 2000; Lezak et al., 2004). During standard clinical assessment mental health professionals often assess such components of executive functioning as impulsivity and insight. Also evaluated, though less often, are thinking processes (e.g., concrete versus flexible).

It is well established that deficits in executive functioning can lead to significant disruptions in everyday functioning, even when other cognitive functions are relatively intact (Bechara, Damasio, & Damasio, 2000). Identification of impaired executive functions and their real world implications (e.g., increased risk for suicidal behavior) are therefore receiving increased research attention (Dougherty et al., 2004; Jollant et al., 2005; Keilp et al., 2001). For example, one study of within-group differences in individuals with a history of at least one suicide attempt found that responses to a laboratory-based measure of impulsivity increased with the number of suicide attempts (i.e., those with the highest number of past suicide attempts responded more impulsively; Dougherty et al., 2004). Studies have also found between-group differences: In an investigation of executive functioning in individuals with a history of suicide attempts, those with affective disorders, and healthy comparison subjects, researchers found that on a decision-making task those who had attempted suicide demonstrated more executive dysfunction (Jollant et al., 2005). Another study found differences between high-lethality suicide attempters and three other groups (low-lethality attempters, depressed subjects, and non-depressed control subjects) with regard to inability to employ a previously successful strategy on a neuropsychological task (Keilp et al., 2001).

Traditional means of suicide risk assessment have often focused on the identification of risk and protective factors. Risk factors are any factors empirically associated with suicide (Rudd et al., 2006). A variety of risk factors identified in the suicide literature are summarized in Table 1. Although knowledge of such factors provides general information about potential sources of increased risk (Brenner & Homaifar, 2009), many (e.g., history of impulsivity, history of substance abuse) are not specific to suicide and have limited utility in predicting behavior. Identifying long-standing risk factors (e. …

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