**2.3 Instruments and screening for mental wellbeing**

### *2.3.1 Conceptual framework of the Response Inventory for Stressful Events (RISLE)*

**Figure 2** presents the conceptual framework of three factors that interact in dynamic ways to engender suicidal behavior. An interaction of two of these factors, depicted as *individual predisposition*, *stressful life events*, and *quality of social capital*, may lead to impulsive self-destructive act or deliberate self-harm, failed suicide act, completed suicide act, recurrent suicide ideation, or repeated suicide urge in response to the experience of difficulties in life. Individual predisposition may take the form of genetic predisposition, the existence of a major psychiatric disorder such as major depressive disorder, affective disorder, or schizophrenia; the diagnosis of a debilitating somatic illness or terminal illness such as malignancy, or an endocrine disorder such as diabetes mellitus. Examples of stressful life events are multiple, and these include unexpected business collapse, loss of employment, failed marriage or sudden end of a relationship, teenage pregnancy, domestic violence, and dropping out of school due to lack of school fees. Examples of quality of social capital include lack of social support to elderly parents who, as a result, may choose to end their lives. Constant harassment of a child or teen by stepmother, neglect of a child by a father, and child abuse or defilement are often potent risk factors for suicidal behavior.

The actual occurrence of a lethal suicidal act happens when all three factors (individual predisposition, a stressful life event, and lack of social capital) act in combination and create the environment for the affected person to view life as intolerable, hopeless, worthless, and meaningless.

#### *2.3.2 The RISLE and self-assessment*

**Table 1** presents the content of the Response Inventory for Stressful Life Events (RISLE). The instrument consists of five subscales that comprise of items, which describe situations relating to one or other of the three pillars of suicidal behavior.

**Figure 2.** *Three pillars of suicide behavior.*



*Lay Counselors' Mental Wellness in Suicide Prevention after Prolonged Mass Trauma… DOI: http://dx.doi.org/10.5772/intechopen.106620*


#### **Table 1.**

*RISLE regression analysis for the mean scores with sex, marital status, and age of participants as demographic characteristics post-training.*

The subscales are *Reaction to stressful events, Attitude to the social world, Attitude to life, Passive death wishes,* and *Active death wishes.* Suicidal persons have poor ability to adapt to and manage stressful events. The characteristic response to encounters with stressors, however minor, is bewilderment, confusion, and failure to be at ease. The overall pattern of behavior in the face of difficulties is maladaptive. Suicidal behavior in the Ugandan setting occurs in an environment of rich social networks. However, suicidal persons view their social networks as not being supportive; their attitude to their social networks is thus negative. In the face of life's difficulties, suicidal individuals view their life situation as intolerable, unbearable; they view themselves as having lost control over their personal and social lives. Passive death wishes refer to a constellation of thoughts, feelings, and urges reminiscent of suicide. Active death wishes, on the other hand, refer to thoughts, plans, and other activities that precede and culminate in a completed suicide. The score on the RISLE is the total of the scores on the five subscales. A high score indicates a high suicide risk. Details of how the score on the RISLE validation is described elsewhere.

In addition to the actual measures of responses to stressors, the RISLE has a section that captures sociodemographic characteristics of every respondent. The instrument is self-administered and asks the respondent to provide his or her response to the experience of each stressful event in the 2 weeks prior to the self-assessment. Respondents choose from one out of four possible responses to every stressful event. The four alternative responses grade the respondent's potential response from a positive and adaptive reaction to a negative maladaptive response depending on his or her life experiences. The content of the RISLE describes the presence of any chronic somatic illness such as HIV/AIDS, the respondent's adequacy of social support, type and level of stress tolerability such as in response to marital difficulty or business collapse, coping ability, and adaptive behavior in the face of difficulty such as impending natural death or execution for murder, etc. Trainee lay counselors completed the 32-item translated *Luo* version of the RISLE questionnaire [11, 12] on the first day of training and immediately after the end of training on the fifth day.

*Lay Counselors' Mental Wellness in Suicide Prevention after Prolonged Mass Trauma… DOI: http://dx.doi.org/10.5772/intechopen.106620*
