By Lanny Berman, Ph.D., ABPP, Executive Director, American Association of Suicidology

IS PATH WARM?
In November, 2003, with funding from the federal government and a private foundation, the American Association of Suicidology (AAS) brought together more than a dozen of the world’s leading clinical researchers and experts in public health messaging to address questions of whether or not we could gain consensus on what defined warning signs for suicide and, if so, how best to package these for the public and for professionals in position to detect them and refer those in need for treatment before suicidal behavior followed.

Prior to the meeting, AAS researchers had conducted an Internet search of “warning signs” and “suicide” and received 183,000 hits. A sampling the first 50 or a randomly selected 200 sites produced 138 distinct warning signs, a list far too cumbersome for anyone’s attention and inclusive of many “signs” that were simply not observable, such as “neurotransmitters.”

Chaired by then president David Rudd and executive director Lanny Berman, the AAS convened conferees, indeed, were able to establish a number of near-term risk factors supported by the research. Unfortunately, even the best of research to date was not able to pin down observed symptoms and behaviors in just the last weeks of life, but the derived list was more specific to the near- versus the long term in the lives of those who had died by suicide.

AAS reframed this list into an acronym, IS PATH WARM?, in order to communicate these observable near-term risk factors in an easily remembered manner to the public. The resulting mnemonic device can be remembered with but little practice and, hopefully, be helpful to recognize when a person at risk has moved from being vulnerable to suicide, to having greater potential of acting on suicide urges, hence the need for a referral and evaluation.

IS PATH WARM?
Ideation – threatened or communicated thoughts of suicide
Substance Use – excessive or increased use of alcohol or drugs
Purposeless – no reason for living
Anxiety – agitation, insomnia
Trapped – feeling there is no way out
Hopelessness
Withdrawal – from family/friends/school
Anger – uncontrolled/rage/seeking revenge
Recklessness – risky acts/unthinking behavior
Mood – changes, often dramatic
Reference

Rudd, M.D., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K., Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36 (3), 255-262.