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Audiologists’ Role in Managing Patient Suicide Risk

Zitelli, Lori AuD; Palmer, Catherine PhD

doi: 10.1097/01.HJ.0000527214.97429.3b
Hearing Loss and Suicide
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Dr. Zitelli, left, is an audiologist at the University of Pittsburgh Medical Center (UPMC) and an instructor at the University of Pittsburgh, where Dr. Palmer is an associate professor. She's also the director of audiology at UPMC, where she opened the Musicians’ Hearing Center.

Patient suicide risk? If you're thinking, “Whoa—that is way outside of my scope of practice!” you would not be alone. The topic of suicide assessment and prevention does not typically come up in casual conversation among audiologists. In fact, many people (health care providers included) are very uncomfortable discussing this matter. A 2012 systematic review found that attitudes of general hospital staff toward self-harm patients are often negative J Affect Disord. 2012;139[3]:205. In many cases, a lack of specific training was thought to contribute to the generally negative attitude held toward these patients. A recent review of counseling syllabi in doctor of audiology programs in the United States revealed that depression, suicide, and self-harm are not included in 91 percent of the syllabi reviewed (Hearing Journal. 2017;70[8]:36). However, training in suicide assessment and prevention may help improve attitudes toward patients at risk of committing suicide and inflicting self-harm.

Table 1

Table 1

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RECOGNIZING WARNING SIGNS

At this point, you may still be wondering why this is something that should be important to audiologists. Many disorders commonly evaluated and treated by audiologists can be linked to comorbid mental health issues (Semin Hear. 2018; in press). Mental health issues are among the most commonly noted risk factors used to predict future suicide attempts (J Psychiatr Res. 2012;46[7]:946). The American Foundation for Suicide Prevention (AFSP) provides several risk factors and signs that indicate the possibility that the person you're interacting with may try to take his or her own life. The AFSP divides these risk factors into three categories: health factors, environmental factors, and historical factors (AFSP, 2017; Table 1).

Warning signs are behaviors that indicate a person might be at risk of engaging in suicidal behavior. The AFSP indicates that individuals who talk about the following topics are at an increased risk of committing suicide—being a burden to others, feeling trapped, experiencing unbearable pain, having no reason to live, and killing themselves. Other behaviors to note include increased use of alcohol or drugs, looking for a way to kill themselves (such as searching online for materials or means), acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, and aggression. AFSP also suggests that people at an increased risk of committing suicide often display moods or emotions such as depression, loss of interest, rage, irritability, humiliation, and anxiety (AFSP, 2017).

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TRAINING FOR AUDIOLOGISTS

Physician education is one way to increase the number of diagnosed and treated depressed patients and reduce suicide incidences (JAMA. 2005;294[16]:2064). However, newly educated physicians have reported significant professional challenges in managing patients at risk of committing suicide (BMC Med Educ. 2006;6[44]:1). First, physicians reported doubts in their ability to establish a relationship wherein the patient will trust them upon initial interactions. Young physicians also noted issues with their ability to competently intervene, citing difficulties in tasks like collecting relevant information, developing a plan based on desired outcomes, and acting in a manner that they believed was ethical (i.e., admitting a patient to a facility for inpatient care against their will). Finally, they reported issues in becoming emotionally involved (feeling indignant, powerless, sorrowful, etc.). Researchers are hopeful that this information can guide those who develop teaching programs with a focus on working with suicidal patients.

Audiologists who are new to the challenge of identifying and managing patients at risk for suicidal behavior may have similar concerns. It may not be appropriate to expect audiologists to function as physicians who evaluate and treat patients with mental health issues or suicide ideation. But with proper training, audiologists can be gatekeepers by identifying signs of depression and other behaviors that put individuals at heightened suicide risk. Gatekeeper training programs have been developed to help those with minimal experience and knowledge about suicidal behavior, resulting in positive changes in knowledge, efficacy, and observable suicide-prevention skills (Crisis. 2010;31[3]:149). Resources include lectures, videos, crisis resource sharing, and discussions with an instructor. These programs should be considered by educators responsible for determining the audiology curricula.

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TAKING ACTION—EVEN WITHOUT FORMAL TRAINING

The National Institute of Mental Health has developed an online toolkit that outlines five actions to help someone in emotional pain and at risk of committing suicide (NIMH, 2017).

  1. Ask “Are you thinking about killing yourself?”
  2. Keep them safe.
  3. Be there.
  4. Help them connect.
  5. Stay connected.

U.S.-based crisis management resources can also be accessed immediately, including information for people who are not able to hear or talk on the phone (www.suicidepreventionlifeline.org). The Lifeline National Suicide Prevention Network provides a hotline available 24 hours a day, seven days a week (1-800-273-TALK [8255]). Contacting emergency services or dialing 911 is always an option if danger is imminent. Other useful resources include a primary care provider, psychiatric hospital, walk-in clinic, hospital emergency department, or an urgent care center (AFSP, 2017).

Audiology and hearing health professionals—and others involved in the field, including students and industry representatives—should be aware of the risk factors and warning signs of suicidal behavior. By continuing to promote awareness of this unrecognized need within our field, we take significant steps toward preventing suicide and breaking down barriers that hinder the open discussion of our patients’ mental health needs and suicide risk.

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