The narrative crisis model of suicide as a framework for suicide prevention

Abstract

The Narrative Crisis Model of Suicide (NCM) is an iterative, dynamic, diathesis-stress model that conceptualizes individuals’ progression to suicidal behavior through the incorporation of four distinct and successive stages. The NCM strives to reflect a paradigm change in the prevention of suicide: rather than assessing individuals’ suicide risk and categorizing them along different risk levels based on their self-reported suicidal ideation at a given time, the NCM proposes to assess psychological vulnerabilities and processes characteristic of critical milestones in the progression from chronic factors to acute suicidal mental states. As a comprehensive model, the NCM provides an empirically grounded conceptual framework for intervention at each stage of the psychological progression towards suicidal action. In this article, we propose stage-specific treatment modalities, moving progressively from acute to chronic risk. Such treatments would first target the acute Suicide Crisis Syndrome (Stage 4), the subacute suicidal narrative (Stage 3), deficits in stress management (Stage 2), and finally long-term risk factors/trait vulnerabilities (Stage 1). Although future research is needed to establish the optimal combination and sequence of empirically-supported interventions, the NCM may be a useful framework to guide innovations in clinical intervention and research.