Assessment of suicidal intention: The Scale for Suicide Ideation

Statistical issues in the identification of risk factors for suicidal behavior: the application of survival analysis

Studies of suicide risk factors generally examine suicidal behavior as a dichotomous outcome. Survival analytic techniques are discussed in which the time until a suicide attempt from a specific point, such as prior attempt or onset of illness, is also examined. These procedures can incorporate information on those lost to followup or "censored." One survival analytic technique, Cox's proportional hazards model, is a particularly informative statistical technique for the study of suicidal risk factors because several covariates can be incorporated. Illustrative analyses estimate the significance of different risk factors, and demonstrate that there is a 32% increase in the relative risk of a suicide attempt associated with each prior attempt.

Anhedonia, suicide ideation and dexamethasone nonsuppression in depressed patients

In the search for a valid analysis of a number of operationalised symptoms common to depressive behaviour, a study was performed comprising 46 patients showing depressive symptoms, according to operationalised criteria and as part of which all agreed to undergo the following tests: (a) psychiatric: Present State Examination; (b) psychological: Hamilton Rating Scale, Montgomery-Asberg Rating Scale, State-Trait Anxiety Inventory, Beck Suicide Ideation Scale, Chapman Anhedonia Scale, Mood Scale, Sleep Quality Scale, Activities Scale, Social Support Scale, Questionnaire on Recently Experienced Events and the Paykel Life Events Interview; and (c) biochemical: Dexamethasone Suppression (DEX) Test. After gathering different depressive subgroups, based on operationalised symptoms, a dichotomy was made in the distributions of the (an)hedonia, suicide ideation and DEX-(non) suppression scores. This study may indicate that anhedonia, suicide ideation and DEX-nonsuppression are the opening to the identification of a subgroup of depressed patients. This symptom complex could not definitely be identified on the basis of existing DSM-III diagnostic entities, because of the known fact that this method of classification is not appropriate for our purposes in revealing pathophysiological processes. It is suggested, therefore, that these symptoms might prove to be the anchor-point from which to reach a better insight into the aetiology and pathogenesis (i.e. the final common pathway) of depression.

Assessment of suicide risk by computer-delivered self-rating questionnaire: preliminary findings

A prospective study of 167 consecutive patients admitted to a general hospital following an episode of deliberate self-harm was carried out; 102 patients were interviewed by computer and then by a psychiatrist who was blind to the results of the computer interview. The computer interview consisted of a self-rating modification of the Hamilton Rating Scale for Depression and a novel questionnaire developed to assess suicidal ideation. This article explores the preliminary findings in these patients and suggests that not only is the computer interview acceptable to the majority of patients but the data suggest, in line with previous studies, that the patients are prepared to confide information to the computer that they may be unwilling to tell the clinician. Further the data also suggest a significant pathoplastic effect of the personality of the patient on the perception of the psychopathology by the clinician. The computer appeared to be a better predictor of suicidality than the interview by the clinician.

Suicidal ideation in a young adult population

Depending on the manner in which the data were interpreted, as many as 17.5% of women and 20.2% of men, or as few as 3.0% of women and 3.3% of men in a young Australian adult population reported some degree of suicidal ideation in the few weeks prior to testing. Using a suicidal ideation score derived from the General Health Questionnaire (GHQ), 11.7% of men and 9.7% women could be considered to have suicidal ideation. These findings and the diversity of results from other studies emphasize the need for standardized methods of assessment of suicidal ideation. The GHQ could be usefully employed for this purpose, particularly as it is widely used and further analysis of existing data could provide valuable comparisons.

Attempted suicide in those with personality disorders. A comparison of depressed and unsocialized suicide attempters

From a sample of 499 patients admitted to hospitals for suicide attempts, a subsample of 182 suicide attempters who described histories of illicit activities or who were diagnosed with DSM-II anti-social, drug or alcohol personality disorders were compared with another sample of 109 suicide attempters diagnosed as having depressive disorders. The former group of unsocialized attempters obtained similar depression inventory scores as the diagnosed depressive attempters. However, the index attempts of the unsocialized group were made with less suicidal intent than those of the diagnosed depressive patients, and they made more prior suicide attempts than the diagnosed depressive patients.

The study of suicidal behavior in the schools

The studies reviewed indicate that suicidal behavior is infrequent among school children (12%), but increases progressively among junior high (35%), high school (65%), and college students (50-65%). Though considerable, these values are lower than those of similar-age psychiatric populations. Estimates of the rate of actual attempts were 3% for elementary students, 11% for high school students, and 15-18% for college students. Most were low-lethality attempts for which medical or other attention was not sought. Accordingly, the vast majority of suicide attempts will not be uncovered by investigations dealing solely with clinical or medically identified populations. The most commonly identified correlates of suicidal behaviors included depressive symptoms, social problems, family disorganization and problems, life stress, and poor problem-solving skills. Academic problems were not as important. These findings must be interpreted in light of methodological constraints. Response rates have been low, samples have been small, minorities have been underrepresented, nonstudents have been ignored, and volunteers of unreported characteristics have predominated. The representativeness of such groups is questionable. The definition and categorization of behaviors have varied considerably, making between-study comparisons difficult. The differences among thoughts, threats, and attempts (the most frequently used categories) have often not been taken into account. Rather, in analyses, these behaviors have been treated as if they were homogeneous entities and grouped together. Where attempters have been separated from ideators, they too have been treated as a single entity. Many deliberately survived attempts are manipulative and oriented toward the benefits the individual survivors expect. Such attempts probably differ substantially in nature from those attempts where survival is not intended. Understanding of this phenomenon could be enhanced by a comparison of the characteristics of those with high- and low-lethality attempts. Similarly, a third group of behaviors--that of chronic behavior patterns that potentially hasten death (alcoholism, drug abuse, self-mutilation, and risk taking)--has not been adequately addressed in terms of its relationship to more discrete suicidal events. Data have generally been obtained via anonymous self-administered questionnaires. The accuracy of retrospective self-reports on emotionally laden events is suspect. Only in two instances have self-reported questionnaire data been validated via interviews with subjects alone or subjects and their families. The time frames on which the referent behaviors has been collected have included "last week", "last month", "last year", "lifetime", and not specified. The longer the interval between the occurrence of the behavior and the report, the greater the likelihood that some reporting inaccuracies may occur.(ABSTRACT TRUNCATED AT 400 WORDS)

The prevalence of suicidal ideation among college students

A total of 737 university students were surveyed using a psychometrically sound self-report measure of suicidal ideation. Over 43% of those participating were found to have experienced some level of suicidal ideation during the previous year. Of those found to have had suicidal thoughts, 14.9% in some way acted on those thoughts without actually making suicide attempts. An additional 5.5% were found to have made attempts on their lives. Serious suicidal ideation and actual attempts were related to several demographic traits, and implications of the results are discussed. In general, findings indicate that the problem of youth suicide may involve a greater percentage of young people than previously thought. Moreover, findings provide indirect support for the hypothesis that the difference in male-female completed suicide rates is primarily a function of the lethality of the attempts.

Scale for Suicide Ideation: psychometric properties of a self-report version

A self-report version of the Scale for Suicide Ideation (SSI) was administered to 50 inpatients diagnosed with mixed DSM-III psychiatric disorders and 55 outpatients with affective disorders. The self-report SSI was written for both paper-and-pencil and computer administration. The correlations between the self-reported and clinically rated versions for both inpatients and outpatients were greater than .90, which suggests strong concurrent validity. The Cronbach coefficient alphas for the paper-and-pencil and computer versions were also in the .90s and indicated high internal consistency. Furthermore, the mean SSI scores of the computer version for both the inpatients and outpatients were higher than the mean SSI scores of the clinical ratings; the patients described more severe suicide ideation than clinicians reported.

Suicide: a guide to risk factors, assessment, and treatment of suicidal patients

This article summarizes what is known about risk factors for suicide in both adolescent and adult populations. It also translates this knowledge base into practical considerations for the physician on the assessment and treatment of suicidal patients. Since most patients who commit suicide have seen a physician in the weeks to month prior to their deaths, and many kill themselves with medications prescribed by their doctors, the physician's early detection and treatment of suicidal behaviors and associated psychiatric disorders in his or her patients becomes a major suicide prevention strategy.

Suicide and course of illness in major affective disorder

The relationship between a history of attempted suicide and prior course of illness was explored in 87 patients with major affective disorder. Fifty-eight percent of bipolar (n = 67) and 50% of unipolar (n = 20) patients had a history of a suicide attempt. Females were more likely to have made an attempt (67%) than males (42%) and were equally likely to have made a violent attempt. Course of illness and prior history of psychosis were similar in patients with and without a history of an attempt. However, in patients who made an attempt, the severity of the worst attempt was positively correlated with the duration of illness. Greater numbers of prior attempts were associated with greater lethality of the worst attempt. Suicidal ideation for the period of most severe depression in the prior 12 months did not correlate with any measure of lethality of suicide attempt. These data not only suggest the need for further studies of suicide in relationship to the longitudinal course of affective illness, but also the need for continuous reappraisal of suicidal risk in patients with recurrent affective disorders.

Cognitive predictors of depression and suicide ideation

A total of 136 adult subjects who met the Research Diagnostic Criteria for major (unipolar) depression were assessed for intensity of depressive symptomatology (using the Hamilton Rating Scale for Depression and the Beck Depression Inventory) and for lethality of current suicide ideation (using the Scale for Suicide Ideation). In addition, they were administered a variety of questionnaires assessing cognitive variables presumed to mediate depression and suicidality. Multiple regression analyses indicated that depressive symptomatology was best predicted by Beck's Hopelessness Scale in combination with the Detachment factor of the Crandell Cognitions Inventory. In addition, suicidality was significantly predicted by the Selective Abstraction and Overgeneralization factors of Lefebvre's Cognitive Error Questionnaire, when the effects of the Beck Depression Inventory were partialed out. The practical implications of these findings for discriminating suicidal from nonsuicidal depressives are discussed.

Test-retest reliability of the Hopelessness Scale and its items in a university population

In a study that used 149 university undergraduates and a 3-week test-retest interval, the stability of the Hopelessness Scale was examined. Scale scores and item responses demonstrated high test-retest reliabilities. Additional analyses indicated significant sex differences on the Hopelessness Scale. It was concluded that the Hopelessness Scale's stability fulfills a prerequisite for it to be a predictor of long-term suicidal risk.

A prospective investigation of suicidal ideation in college students: a test of a model

In order to test the predictive validity of a stress--vulnerability model of suicide ideation and behavior, a longitudinal study was conducted with college undergraduates. Based on previous research (Bonner & Rich, 1987; Rich & Bonner, 1987a), measures of social/emotional alienation, adaptive resources for living, and cognitive rigidity were taken at the beginning of the semester and combined to develop a vulnerability score. Then, at midterm, measures of midterm stress and cumulative negative life stress were obtained from the same subjects. It was hypothesized that the vulnerability factor would interact with midterm and negative life stress to predict suicide ideation. Instead of an interactive model, a linear, compensatory model of suicide ideation was found. The combination of alienation, deficient adaptive resources, and life stress best predicted ideation scores. Implications for research and theory are noted.

Relationships of depression, hopelessness, and dysfunctional attitudes to suicide ideation in psychiatric patients

Computerized versions of the Beck Depression Inventory, Hopelessness Scale, Dysfunctional Attitude Scale, and Scale for Suicide Ideation were administered to 50 inpatients diagnosed with mixed psychiatric disorders and 25 outpatients diagnosed with affective disorders. The scale scores were positively related to suicide ideation and the magnitudes of the correlations were comparable. Controlling for a prior suicide attempt, a stepwise multiple-regression analysis indicated that the Beck Depression Inventory and Dysfunctional Attitude Scale contributed unique variance to the explanation of the inpatients' Scale for Suicide Ideation scores. Only the Beck Depression Inventory contributed unique variance to the explanation of the outpatients' Scale for Suicide Ideation scores. A stepwise multiple-regression analysis of the 40 Dysfunctional Attitude Scale items on the inpatients' Scale for Suicide Ideation scores showed six dysfunctional attitudes (perfectionism and sensitivity to social criticism) explained about 77% of the variance. Results reaffirmed the importance of depression, in addition to hopelessness, as a syndrome associated with suicide ideation and indicated that dysfunctional attitudes, such as perfectionism, may yield additional information about suicidal risk.

'Deradiating' the former uranium capital

Background

The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses’ Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments.

Objective

The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors.

Methods

The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool’s internal structure. The tool’s reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected.

Results

Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023.

Conclusions

We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management.

International Registered Report Identifier (IRRID)

PRR1-10.2196/39482

Assessment of suicide risk

Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

Toward a predictive model of suicidal ideation and behavior: some preliminary data in college students

Within a multivariate statistical design, the relationship of various interpersonal, emotional, and cognitive variables to suicidal ideation and behavior in college students was examined. A total of 158 subjects (58 males, 100 females) completed self-report measures of life stress, faulty cognitions, loneliness, depression, hopelessness, family cohesiveness, adaptive reasons for living, and suicidal ideation and behavior. The results of a multiple-regression analysis, forward-inclusion algorithm, indicated that a predictive equation consisting of loneliness, irrational beliefs, and low adaptive reasons for living best accounted for suicidal behavior scores. To determine the basic structures and power of the predictor variables under study, a factor analysis and composite regression were employed, resulting in a predictive equation consisting of three factors: Social/Emotional Alienation, Cognitive Distortions, and Deficient Adaptive Resources. Results are discussed in terms of an interactional model of suicidal behavior.

The Hopelessness Scale and social desirability: more data and a contribution from the irrational beliefs test

This paper presents findings with regard to social desirability confounding on Beck's Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). Data from 60 suicidal and nonsuicidal psychiatric inpatients were examined in terms of the correlations between hopelessness scores and suicidality. Controlling for social desirability, as measured by the Marlowe-Crowne Scale (Crowne & Marlowe, 1964), did not affect this correlation substantially, nor did use of SD scores in a discriminant analysis improve accuracy of classification into severely suicidal and nonsuicidal groups. These results are in contrast with similar studies (e.g., Linehan & Nielsen, 1981) that used the Edwards SD scale. However, regression analysis of the MCSD scale using subscales of the Irrational Beliefs Test (Jones, 1969) raises the question as to whether the MCSD scale indeed is measuring SD, as opposed to some aspect or aspects of psychological adjustment.

Suicide attempters, ideators and risk-taking propensity

The personality dimensions related to risk-taking propensity in suicide patients were sought. Two dimensions, responsibility and self-esteem, were helpful in distinguishing between suicide involved patients, and non-suicide related cases.

Factorial structure of the aftermath of suicide instrument

Initial factor-analytic studies of the Aftermath of Suicide Instrument suggested that there may be four broad areas of social reaction to suicide. In a replication study, this 25-item questionnaire was administered to a community sample of 54 persons aged between 21 and 77 years. Factor analysis of their responses identified five factors, but only one of these was similar to any of the original factors. This marked variation is probably due to differences in the population sampled, with the present group of respondents more heterogeneous. While the content of the Aftermath of Suicide Instrument remains valid, it appears that its factorial structure requires further clarification. This is consistent with the emotional and clinical complexities of the subject of suicide.

Assessment of Suicide Risk: Some Limitations in the Prediction of Infrequent Events

Efforts to predict suicide and attempted suicide generally have yielded equivocal results. Neither single signs, standard psychological tests, specially devised tests, clinical judgments nor scales are found to be able to predict suicide at useful levels. Prediction of suicide is hampered by the relative rarity of this behavior together with the inadequate specificity of clinical characteristics and antecedent events. No highly unique descriptive attributes of suicide committers have been discovered. Within these existing limitations, a set of potential predictor variables are presented that may result in improved prediction of suicidal risk.