Suicide and intimate partner violence

A federal initiative aims to bring experts from the two fields closer together in an effort to save lives.

By Rebecca A. Clay

2014, Vol 45, No. 10


Suicide and intimate partner violence are both major public health crises, and they're closely linked, says Richard McKeon, PhD, chief of the suicide prevention branch at the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).


Survivors of intimate partner violence are twice as likely to attempt suicide multiple times, he points out, and cases of murder-suicide are most likely to occur in the context of abuse.


Yet despite the clear link, the mental health and intimate partner violence fields have historically worked in isolation. Now that's starting to change. Over the last two years, SAMHSA has been working to bring the two fields closer together. The psychologists and other experts involved in the effort have been reviewing the research, creating webinars and other educational resources and exploring additional ways to ensure that those working in suicide prevention don't miss signs of intimate partner violence and those working in intimate partner violence don't miss suicide warning signs.


When each field isn't educated about the other, the results can be deadly, says McKeon. For example, people working in the intimate partner violence field may minimize suicide threats made by perpetrators of violence as simply attempts to manipulate partners. Such threats, however, indicate a genuine risk of harm to both perpetrators and their victims.


Similarly, says McKeon, if someone comes to the emergency room because of a suicide attempt or because of intimate partner violence, "It's very important to inquire if intimate partner violence is taking place or if they're having suicidal thoughts."


The SAMHSA group includes scholars, government representatives, advocates, leaders of community-based programs and others interested in the connections between suicide and intimate partner violence and ways to raise awareness in both fields. Several psychologists are among the group, including McKeon, APA President Nadine J. Kaslow, PhD, and National Suicide Prevention Lifeline Director John Draper, PhD.


"This is work that's really just beginning, but we think we've brought the right people together to think it through and help work on educating both fields about what they need to know about the work going on in suicide prevention and intimate partner violence, respectively," says McKeon.


With the group's help, SAMHSA has produced two webinars to increase awareness of the issues. The webinars are available at SAMHSA's Suicide Prevention Resource Center. The group also expects to release two tip sheets in the coming months, one aimed at suicide prevention and crisis hotline workers and the other for professionals focused on intimate partner violence.


At a groundbreaking meeting of the two fields SAMHSA hosted in July, the group also identified several future priorities, including increasing collaboration between the Lifeline and the National Domestic Violence Hotline so that workers at each hotline are aware of both suicide and intimate partner violence-related resources. In addition, the group wants to find ways to intervene with children who have witnessed intimate partner violence.


Even psychologists may overlook the interplay between suicide and intimate partner violence, says Kaslow, explaining that training programs often don't include information linking the two.


"When people come in because of intimate partner violence, psychologists often pay more attention to the violence in their lives instead of how helpless and hopeless that violence makes them feel," says Kaslow, a professor of psychiatry and behavioral sciences at Emory University Medical School. "They may feel the only way out is to kill themselves. Similarly, people will come in after a suicide attempt, but if you don't ask directly about violence, they often are too ashamed to talk about it or don't see the connection and don't volunteer information."


Psychologists and other health professionals can avoid such problems by asking specifically about intimate partner violence and then addressing safety concerns, says Huaiyu Zhang, PhD, a former member of Kaslow's team at Emory who is helping to develop one of the tip sheets. If a client is experiencing intimate partner violence, she says, the first step should be to create strategies to keep the client safe and help him or her develop coping skills. Motivational interviewing can help clients understand why they're in abusive situations and help them make positive changes.


Empathy is key, says Zhang, now an assistant professor of psychology in Indiana University's psychiatry department. "Our natural tendency is to want to help them get out of the intimate partner violence situation," she says. "However, these patients are stuck in these situations for a reason, so it's important to be empathic about those situations."


And don't overlook men, adds Denise A. Hines, PhD, who spoke at an APA 2014 Annual Convention session co-chaired by Kaslow as another way to spread the word among psychologists. According to the U.S. Centers for Disease Control and Prevention, one in 10 American men experience physical violence, rape or stalking by an intimate partner.


"Partner violence against men by women happens much more than most mental health professionals realize, and the initial evidence also suggests that male victims are also at risk for suicide," says Hines, an associate research professor of psychology at Clark University.


Rebecca A. Clay is a journalist in Washington, D.C.