Suicide risk in schizophrenia: Explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS)
Article first published online: 24 DEC 2010
2008 The British Psychological Society
Psychology and Psychotherapy: Theory, Research and Practice
Volume 81, Issue 1, pages 55–77, March 2008
How to Cite
Johnson, J., Gooding, P. and Tarrier, N. (2008), Suicide risk in schizophrenia: Explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychology and Psychotherapy: Theo, Res, Pra, 81: 55–77. doi: 10.1348/147608307X244996
- Issue published online: 24 DEC 2010
- Article first published online: 24 DEC 2010
- Received 6 November 2006; revised version received 11 May 2007
Purpose. The objective of this paper was to evaluate the Cry of Pain model of suicide behaviour as applied to psychosis and to derive theoretically driven guidelines for prevention. Suicide risk in psychotic patients is a serious but poorly understood clinical and social problem. There is a dearth of psychological models to explain suicidal behaviour and to guide effective preventative clinical interventions. Understanding suicidal behaviour in psychosis may be facilitated by utilizing models from depression. The ‘Cry of Pain’ model of suicide is founded on an evolutionary approach to understanding suicidal behaviour in depression.
Methods. The model was critically evaluated and relevant literature reviewed.
Results. Although strengths of the model were identified, lack of clarity regarding the concepts of defeat, entrapment, and lack of rescue appeared to limit its theoretical and clinical utility. We suggest a modification to this model which replaces concepts of defeat, entrapment, and lack of rescue with a four-stage appraisal process in conjunction with information-processing biases and suicidal schema.
Conclusions. Methods of testing this model are suggested and guidelines for a clinical intervention (Cognitive Behavioural Suicide Prevention for Psychosis; CBSPp) are outlined.