Identifying the patients who dwell in this state can be tricky, especially when assessment tools largely identify patients who think about suicide, not necessarily those who will make an attempt.
"We need to improve suicide risk assessment … and provide treatment that mitigates that risk," Lineberry said. "Suicidal ideation is not as helpful as people think it is," although insurance companies seem to think it is the key.
Among Galynker's 40 questions that comprise the Suicide Trigger Scale, patients are asked whether, when they're very anxious, they think their "head could explode from too many thoughts," if "there is no exit" or if "the world is closing in on you."
But the most important question, Galynker said, is the one asking "do you feel trapped."
"The way suicidal thoughts progress is as long as there is some kind of exit, there is a door, there is hope. When there is no place to go; that is where the pain becomes intolerable," he said.
He plans to survey 300 patients who are admitted to the Beth Israel Medical Center who are at a high risk for suicide or who have attempted suicide. They are then reinterviewed in two months, and again in a year.
The patients are also given another set of questions, the Symptom Checklist-90-R. Galynker believes his assessment tool will be more accurate than the SCL-90-R in predicting whether patients will attempt suicide that year.
One key difference in Galynker's questionnaire, compared to other assessment tools, is that he does not ask if the patient plans to commit suicide; instead, he's attempting to capture the feelings associated with suicidal behavior.
"Feelings are older than thoughts," he said.
Suicide Rates Rise Among the Middle-Aged
Dr. Paula Clayton, Medical Director of the American Foundation for Suicide Prevention, an organization funding Galynker's research, says suicide rates are "alarmingly up."
Before the 80s, suicide rates were high and then eventually dropped when antidepressants became widely used. But since 2004, Clayton says suicide rates started to rise again, particularly among men and women between 40 and 65 years old.
"It's scary because the highest suicide rates were always in the elderly," Clayton said.
Preliminary CDC data from 2009 now indicates suicide is the 10th leading cause of death -- it used to be 11th -- and Clayton says it's the only cause of death among the top 20 causes that rose in ranking. The same data also shows 36,547 suicides occurred in 2009, up from 34,000 in 2007.
The rise is partly because of the recession.
"There has always been a correlation between unemployment and suicide. That was clear even during the Great Depression," Clayton said.
If Galynker's Suicide Trigger Scale is effective, it might not only help patients get the help they need, but it could also help doctors, too.
"[Suicide] has a profound impact on clinicians and families," Lineberry said, "and that's part of the reason so many of us are in suicide prevention."
Suicide Prevention Resources
Click here to read facts about suicide and learn more about the many resources available to help prevent it.