Use of the MMPI in the prediction of suicide

Risk Assessment on Suicide Death and Attempt among Chinese Rural Youths Aged 15-34 Years

Background: Although many suicide risk assessment tools are available in the world, their validity is not adequately assessed. In this study, we aimed to develop and evaluate a suicide risk assessment model among Chinese rural youths aged 15–34 years. Method: Subjects were 373 suicide deaths and 507 suicide attempters aged 15–34 years in three Chinese provinces (Shandong, Liaoning, and Hunan). Information about the community residents was also collected as the control groups. Social-demographic, social and psychological variables were examined for the suicides, suicide attempters, and community residents. Logistic regressions based on subjects from Shandong and Liaoning provinces were conducted to establish the suicide risk assessment models. Receiver operating characteristic (ROC) curves were drawn, and area under the ROC curves (AUC) were calculated to show how well the models separated the group being tested into those with and without suicide attempt or suicide. Results: The assessment model for suicide death included education years (OR = 0.773, p < 0.001), agricultural worker (OR = 2.091, p < 0.05), physical health (OR = 0.445, p < 0.05), family suicide history (OR = 6.858, p < 0.001), negative life events (OR = 1.340, p < 0.001), hopelessness (OR = 1.171, p < 0.001), impulsivity (OR = 1.151, p < 0.001), and mental disorder (OR = 8.384, p < 0.001). All these factors were also supported in the assessment model for suicide attempt, with an extension of very poor economic status (OR = 1.941, p < 0.01) and social interaction (OR = 0.855, p < 0.001). The AUC was 0.950 and 0.857 for the sample used to establish the assessment models of suicide death and attempt, respectively. The AUC was 0.967 and 0.942 for the sample used to verify the established assessment models of suicide death and attempt, respectively. Conclusions: Compared with some other assessment tools, the models for suicide death and attempt in the current study performed well among Chinese rural youths aged 15–34 years. A reliable suicide risk assessment approach, which includes multiple risk factors, should be evaluated in various cultures and populations.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal–Psychological Theory of Suicide With MMPI-2-RF Scales

Given the emerging body of literature demonstrating the validity of the interpersonal–psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale–based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

The clinical utility of the MMPI-2-RF Suicidal/Death Ideation Scale

Suicide is a major public health concern, with over 100 individuals dying by suicide per day in the United States alone. Therefore, suicide risk assessment is an essential aspect of mental health care. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008-2011; Tellegen & Ben-Porath, 2008) has a Suicidal/Death Ideation (SUI) scale consisting of 5 items that describe recent suicidal ideation or behaviors. Although this scale has clear face validity, few studies have examined the clinical utility of this scale. The purpose of the current study was to examine associations between the SUI scale and other established measures of suicidal ideation and behavior, including the Depressive Symptom Inventory Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997), Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991; Beck, Steer, & Ranieri, 1988), self-report of lifetime suicide attempts, and clinician ratings of suicide risk. Participants were 998 therapy- and assessment-seeking outpatients. Analyses indicated that the SUI scale was positively associated with other self-reported measures of suicidal ideation and behavior. Significant differences in SUI scale scores also emerged among the clinician rating categories of suicide risk. The SUI scale was able to predict previous suicide attempts over and above age, gender, and other MMPI-2-RF scales related to depression. Finally, relative risk ratios for suicide attempts indicate increased risk of suicidality, with higher T scores on the SUI scale. Overall, findings suggest that the MMPI-2-RF SUI scale may be a useful tool for identifying individuals at risk for suicidal ideation and behavior in clinical settings.

Psychological strains found in the suicides of 72 celebrities

The interpretation of suicide involves theories from many disciplines, and the strain theory of suicide is a social-psychological model that attempts to account for this complicated behavior. We have earlier explored the presence of psychological strains in a number of diverse samples of suicides and in the present study, we identified the strains experienced throughout the lives as documented in the biographies of 72 celebrities. The biographies were systematically identified through a number of requirements and composed by one of the authors of this study years before the strain theory of suicide was proposed. A graduate student coder, who was unaware of the strain theory of suicide, was hired to carry out a content analysis of the biography essays and categorize the life events and the responses of the suicide in terms of the four types of strains. Of the 72 suicides, one had no strains, one had all the four strains, four had only one, 30 had two, and 36 had three strains. The most common strain was aspiration strain (97%), followed by deprivation strain (89%), value strain (54%) and coping deficiency strain (4%). It is also noted that religious celebrities were more likely to experience value strain, while those celebrities who had experienced a downhill path in their careers were more likely to experience deprivation and coping strains. This analysis of the 72 celebrity suicides supported the strain theory of suicide.

MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls

Results from the Minnesota Multiphasic Personality Inventory (MMPI) were compared for three groups of male inmates in federal penitentiaries: 47 suicide completers, 43 suicide attempters and, 123 non-suicidal controls. Analyses show that the groups differed on all 10 clinical scales and on at least 8 after Bonferroni correction. Attempters obtained the highest scores on 4 of 8 scales; they also posted the highest scores on 3 others, but differences were significant only against non-suicidal controls. Completers posted the highest score on only one scale (Mf), but the difference was significant only against non-suicidal controls. All told, completers proved more similar to non-suicidal controls than to attempters. Regarding profiles, completers are more strongly correlated with non-suicidal controls (r=0.95) than with attempters (r=0.86); non-suicidal controls are less strongly correlated with attempters (r=0.88). The fact that attempters seem more pathological than the others can mislead clinicians screening for suicide risk.

The utility of MMPI-2 suicide items for assessing suicidal potential: development of a Suicidal Potential Scale

The assessment of suicidal potential is one of the most challenging and stress-inducing tasks facing clinicians. Studies that have attempted to identify specific MMPI codetypes, scales, or individual items predictive of completed suicide have produced inconsistent findings. This study focused on the relationship between the six most direct MMPI-2 suicide items (Items 150, 303, 506, 520, 524, and 530) and verbally reported history of suicidal ideation and behavior among a sample of psychotherapy outpatients (n =116). These six MMPI-2 suicide items provided valuable information regarding suicidal ideation and behavior above and beyond that of verbal self-report. These items were grouped together to create a single scale, the Suicidal Potential Scale (SPS) that manifested strong internal consistency. The SPS provides the clinician with a reliable method of assessing for self-reported suicidal ideation and behavior.

Codetype base rates for the "I Mean Business" suicide items on the MMPI-2

This study focused on the frequency with which two MMPI-2 suicide items (506 and 520) were endorsed. These two items can be referred to as the "I Mean Business" items, for there is no denying that the client is reporting the recent contemplation of actively taking his or her life. A large sample (N = 23,646) of well-defined MMPI-2 codetypes was examined from the Caldwell (1997) data set. The frequencies with which individuals within a particular codetype endorsed Item 506, Item 520, or both are provided by gender. Results provide information that is consistent with the clinical lore concerning suicidal ideation/intent and codetypes. Unexpected findings are also noted. The implications of these base rates in psychotherapy are discussed from clinical and risk management perspectives.

Clinical utility of the MMPI in the evaluation of adolescent suicide attempters

MMPI profiles of female adolescents hospitalized on a general pediatrics floor following a suicide attempt were compared to a control group of medically hospitalized, female adolescents referred for psychiatric evaluation. The suicide attempters had only a lower score on the K scale when compared to the control group. Results do not suggest that a single MMPI profile differentiates suicide attempters from a comparison group of adolescents with emotional difficulties. Implications of these findings are discussed.

Suicide and the MMPI: a cross-validation of predictors

Compared a suicide-completion group to a psychiatric control sample on the 13 traditional MMPI scales, three experimental item pools, and eight profile patterns earlier described as indicative of suicidal tendencies (N = 84). Also compared the frequencies with which the groups endorsed each of the 566 MMPI items. The number of resulting significant differences was less than chance. The results argue against the use of the MMPI to predict suicide at this time.

Identification of suicidal episodes with the MMPI

Previous research has not identified MMPI scales, patterns or item sets capable of separating eventual suicide committers from non-committers. Looking for MMPI scales associated with a short-term suicide state, we compared the scores of people who had committed suicide soon after taking the inventory with those of people who killed themselves more than three months later. The Suicide Episode group showed a significantly higher mean score than the Remote Suicide sample on Paranoia, and near-significant differences appeared on six other scales. These results suggest that it may be possible to identify a suicide state with the MMPI, but further research should precede clinical application of these findings.

Identification of suicide attempters by means of MMPI profiles

Used multivariate procedures to determine whether psychiatric patients who had made a suicide attempt immediately prior to hospitalization (N = 161) could be differentiated from nonsuicidal psychiatric patients (N = 161). Multivariate analysis of variance and cluster analysis failed to identify differences in the MMPI data of suicidal and nonsuicidal patients. In contrast, discriminant analysis produced a modest degree of differentiation that generally was maintained in the cross-validation.

MMPI ratings of suicide risk

Among past attempts to use MMPI data to predict suicidal behavior, there has been a lack of research on the ability of clinicians to identify MMPI profiles of suicidal persons. In this study, the MMPI profiles of 20 male psychiatric patients who committed suicide and the MMPI profiles of 20 male patients who did not attempt or commit suicide were presented to six clinical psychologists with expertise in MMPI interpretation. The clinicians were asked to classify each MMPI profile as coming from a patient who did or did not later commit suicide, and to rate eight variables thought to be relevant to the assessment of suicide risk. Data analysis revealed that the clinicians could not identify suicide and nonsuicide patients from their MMPI profiles. Furthermore, the ratings of the eight suicide variable did not differentiate suicide and nonsuicide patients.