IS PATH WARM?

IS PATH WARM? is an acronym utilized as a mnemonic device. It was created by the American Association of Suicidology to help counselors and the general public "remember the warning signs of suicide."[1][2]

The acronym

I Ideation Threatening to hurt or kill self; looking for ways to die
S Substance Abuse Increased or excessive substance use (alcohol or drugs)
P Purposelessness No reason for living; no sense of purpose in life
A Anxiety Anxiety, agitation; unable to sleep
T Trapped Feeling trapped - like there's no way out; resistance to help
H Hopelessness Hopelessness about the future
W Withdrawal Withdrawing from friends, family and society; sleeping all the time
A Anger Rage, uncontrolled anger; seeking revenge
R Recklessness Acting recklessly or engaging in risky activities, seemingly without thinking
M Mood Changes Dramatic mood changes

Predictive value

Reviews from the psychiatric literature regarding the "IS PATH WARM" mnemonic have been mixed. Several studies have confirmed that some of the acronym's warning signs are associated with suicidal ideation. For example, one 2011 study compared individuals who reported suicidal ideation with people who did not. The study found that respondents who exhibited the "IS PATH WARM" warning signs were more likely to have thought about suicide. (However, illicit drug use and anxiety were not associated with suicidal ideation.)[3]

In another study published a year later, researchers compared 215 postings on an online "suicide forum" with 94 postings on a "self-injury forum."[4] They found that posters in the 'suicide forum' were more likely than those in the 'self-injury forum' to express suicidal ideation, purposelessness, feeling trapped, and social withdrawal. (However, they were less likely than those in the self-injury forum to express recklessness.) The study concluded that individuals who exhibit "IS PATH WARM" warning signs were more likely to have suicidal ideation.

However, the psychiatric literature has been critical of the "IS PATH WARM" mnemonic's value in predicting suicidal behavior. A white paper prepared for the United States Fire Service's Suicide and Depression Summit stated that the acronym's "utility has been hampered by both limited sensitivity and weak specificity."[5] A 2011 study was also critical of "IS PATH WARM"'s validity, finding that none of the ten warning signs were able to predict completed suicides.[6]

Similarly, a large study of 4,050 subjects (half of whom reported suicidal ideation) found that only one of the acronym's ten warning signs - aggression - actually predicted suicidal behavior.[3] The study concluded:

"These findings lend little support for the notion that the IS PATH WARM warning signs are an effective tool for distinguishing those who will exhibit suicidal behavior ... Perhaps the IS PATH WARM warning signs are a useful tool for monitoring patients for suicide ideation, but not for predicting suicidal behavior."[3]p.152

According to a review of school-based suicide prevention, an additional concern is that the IS PATH WARM warning signs were based on risk factors for suicide that appear across the lifespan. Having not been evaluated independently for youth, the author writes, the acronym's value in predicting suicidal behavior in children is uncertain.[7]

Educational value

In creating the "IS PATH WARM" mnemonic, one of the American Association of Suicidology's stated goals was to aid the general public in learning and recalling the warning signs of suicide. The Society's "IS PATH WARM" webpage explains: "These warning signs were compiled by a task force of expert clinical-researchers and 'translated' for the general public."[1]

As an educational tool, "IS PATH WARM" has received widespread exposure. For example, it has been disseminated in suicide prevention materials from such diverse sources as the Substance Abuse and Mental Health Service Administration's National Suicide Prevention Lifeline;[8] the Canadian Association for Suicide Prevention;[9] the New York State Department of Correctional Services Training Academy;[10] and the United States Navy,[11] among many others.

Research regarding whether the mnemonic achieves its educational goals has been limited. However, a 2009 study compared two groups of airmen participating in the United States Air Force Suicide Prevention Program (AFSPP). One group received the Program's standard briefing, which did not include "IS PATH WARM," while the other received the standard briefing along with information about the mnemonic.[12] The researchers concluded:

"Participants in the standard briefing significantly increased their ability to list suicide warning signs and improved consistency with an expert consensus list, whereas participants in the standard briefing plus mnemonic demonstrated no learning. ... Results suggest that inclusion of the mnemonic in the AFSPP briefing interfered with participants' ability to learn suicide warning signs, and that increased confidence in the perceived ability to recognize suicide risk is not related to actual ability to accurately recall warning signs."[12]

See also

References

  1. 1 2 "Know the Warning Signs of Suicide". Suicidology.org. American Association of Suicidology. Retrieved February 3, 2016.
  2. ↑ Juhnke, G. A., Granello, P. F., & Lebrón-Striker, M.A. (2007). IS PATH WARM? A suicide assessment mnemonic for counselors (ACAPCD-03). Alexandria, VA: American Counseling Association.
  3. 1 2 3 Gunn JF; Lester D; et al. 2011. "Testing the Warning Signs of Suicidal Behavior Among Suicide Ideates Using the 2009 National Survey on Drug Abuse and Health" (PDF). International Journal of Emergency Mental Health 13 (3): 147–154. Retrieved February 3, 2016.
  4. ↑ McSwain S; Lester D; et al. 2012. "Warning Signs for Suicide in Internet Forums". Psychological Reports 111 (1): 186–188. doi:10.2466/12.13.PR0.111.4.186-188.
  5. ↑ Gist, Richard; Taylor, Vickie H.; & Raak, Scott (July 2011). White Paper: Suicide Surveillance, Prevention, and Intervention Measures for the U.S. Fire Service – Findings and Recommendations for the Suicide and Depression Summit (PDF) (Report). p. 18. Retrieved February 3, 2016. Acronym models for screening based on factors and characteristics known to be associated with suicidality have been proposed and are in common usage (e.g., “SAD PERSONS” and “IS PATH WARM”) but their utility has been hampered by both limited sensitivity and weak specificity.
  6. ↑ Lester D; McSwain S; et al. 2011. "A Test of the Validity of the IS PATH WARM Warning Signs for Suicide". Psychological Reports 108 (2): 402–404. doi:10.2466/09.12.13.PR0.108.2.402-404.
  7. ↑ Berman AL 2009. "School-Based Suicide Prevention: Research Advances and Practice Implications". School Psychology Review (National Association of School Psychologists) 38 (2): 233–238. doi:10.1521/suli.2009.39.2.194.
  8. ↑ "Materials". National Suicide Prevention Lifeline. Substance Abuse and Mental Health Services Administration. Retrieved February 3, 2016.
  9. ↑ "Warning Signs". CASP/ACPS Sharing HOPE & Resiliency. Canadian Association for Suicide Prevention / Association canadienne pour la prévention du suicide (CASP/ACPS). Retrieved February 3, 2016.
  10. ↑ "Suicide Prevention and Intervention" (PDF). NYSED Office of the Professions. New York State Education Department (NYSED). Retrieved February 3, 2016.
  11. ↑ "Navy Suicide Prevention: Warning Signs of Suicide" (PDF). United States Navy Suicide Prevention. United States Navy. Retrieved February 3, 2016.
  12. 1 2 Bryan CJ; Steiner-Pappalardo N; et al. 2009. "Exposure to a Mnemonic Interferes with Recall of Suicide Warning Signs in a Community-Based Suicide Prevention Program". Suicide and Life-Threatening Behavior 39 (2): 194–203. doi:10.1521/suli.2009.39.2.194.
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