The Family of Instruments That Assess Suicide Risk

Measuring attitudes towards suicide: Preliminary evaluation of an attitude towards suicide scale

OBJECTIVES

Our study aimed to validate a previously published scale assessing attitudes towards suicide. Factor structure, convergent and discriminant validity, and predictive validity were investigated.

METHOD

Adult German participants (N=503; mean age=24.74years; age range=18-67years) anonymously completed a set of questionnaires. An exploratory factor analysis was conducted, and incongruous items were deleted. Subsequently, scale properties of the reduced scale and its construct validity were analyzed. A confirmatory factor analysis was then conducted in an independent sample (N=266; mean age=28.77years; age range=18-88years) to further confirm the factor structure of the questionnaire.

RESULTS

Parallel analysis indicated a three-factor solution, which was also supported by confirmatory factor analysis: right to commit suicide, interpersonal gesture and resilience. The subscales demonstrated acceptable construct and discriminant validity. Cronbach's α for the subscales ranged from 0.67 to 0.83, explaining 49.70% of the total variance.

CONCLUSIONS

Positive attitudes towards suicide proved to be predictive of suicide risk status, providing preliminary evidence for the utility of the scale. Future studies aiming to reproduce the factor structure in a more heterogeneous sample are warranted.

Inter-rater reliability of the German version of the Nurses' Global Assessment of Suicide Risk scale

In comparison to the general population, the suicide rates of psychiatric inpatient populations in Germany and Switzerland are very high. An important preventive contribution to the lowering of the suicide rates in mental health care is to ensure that the risk of suicide of psychiatric inpatients is assessed as accurately as possible. While risk-assessment instruments can serve an important function in determining such risk, very few have been translated to German. Therefore, in the present study, we reported on the German version of Nurses' Global Assessment of Suicide Risk (NGASR) scale. After translating the original instrument into German and pretesting the German version, we tested the inter-rater reliability of the instrument. Twelve video case studies were evaluated by 13 raters with the NGASR scale in a 'laboratory' trial. In each case, the observer's agreement was calculated for the single items, the overall scale, the risk levels, and the sum scores. The statistical data analysis was conducted with kappa and AC1 statistics for dichotomous (items, scale) scales. A high-to-very high observers' agreement (AC1: 0.62-1.00, kappa: 0.00-1.00) was determined for 16 items of the German version of the NGASR scale. We conclude that the German version of the NGASR scale is a reliable instrument for evaluating risk factors for suicide. A reliable application in the clinical practise appears to be enhanced by training in the use of the instrument and the right implementation instructions.

Are There Linguistic Markers of Suicidal Writing That Can Predict the Course of Treatment? A Repeated Measures Longitudinal Analysis

The purpose of this pilot study was to predict resolution of suicidal ideation and risk over the course of therapy among suicidal outpatients (N = 144) using a novel method for analyzing Self- verses Relationally oriented qualitative written responses to the Suicide Status Form (SSF). A content analysis software program was used to extract word counts and a repeated measures longitudinal design was implemented to assess improvement over time. Patients with primarily Relationally focused word counts were more likely to have a quicker suicide risk resolution than those with more Self-focused word counts (6-7 sessions versus 17-18 sessions). Implications of these data are discussed, including the potential for enhancing treatment outcomes using this method with individuals entering treatment.

Relationships among depressive, passive-aggressive, sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults

OBJECTIVES

Suicide among older adults is a major public health problem in the USA. In our recent study, we examined relationships between the 10 standard DSM-5 personality disorders (PDs) and suicidal ideation, and found that the PD dimensions explained a majority (55%) of the variance in suicidal ideation. To extend this line of research, the purpose of the present follow-up study was to explore relationships between the four PDs that previously were included in prior versions of the DSM (depressive, passive-aggressive, sadistic, and self-defeating) with suicidal ideation and reasons for living.

METHOD

Community-dwelling older adults (N = 109; age range = 60-95 years; 61% women; 88% European-American) completed anonymously the Coolidge Axis II Inventory, the Reasons for Living Inventory (RFL), and the Geriatric Suicide Ideation Scale (GSIS).

RESULTS

Correlational analyses revealed that simple relationships between PD scales with GSIS subscales were generally stronger than with RFL subscales. Regarding GSIS subscales, all four PD scales had medium-to-large positive relationships, with the exception of sadistic PD traits, which was unrelated to the death ideation subscale. Multiple regression analyses showed that the amount of explained variance for the GSIS (48%) was higher than for the RFL (11%), and this finding was attributable to the high predictive power of depressive PD.

CONCLUSION

These findings suggest that depressive PD features are strongly related to increased suicidal thinking and lowered resilience to suicide among older adults. Assessment of depressive PD features should also be especially included in the assessment of later-life suicidal risk.

Determining the effects of films with suicidal content: a laboratory experiment

BACKGROUND

Media stories on suicide can increase suicidal ideation, but little is known about variations in media effects with regard to audience vulnerability and story contents.

AIMS

We investigated the impact of three drama films with suicidal content that varied with regard to the final outcome (suicide completion, mastery of crisis and death by natural causes) and tested the moderating effect of baseline suicidality of the participants on the effects.

METHOD

Within a laboratory setting, we randomly assigned 95 adults to three film groups. We used questionnaires to analyse the effects of the films on mood, depression, life satisfaction, self-worth, assumed benevolence of the world and suicidality, as well as identification with the protagonist. We stratified the sample into participants with suicidal tendencies above and below the sample median.

RESULTS

The film that ended with the protagonist's suicide led to a deterioration of mood particularly in individuals with baseline suicidality below the median, who also experienced an increase in self-worth. Participants with stronger suicidal tendencies experienced a rise in suicidality that depended on their level of identification with the protagonist. The film featuring the main character positively coping with his crisis increased life satisfaction particularly among participants with higher suicidal tendencies.

CONCLUSIONS

The effects of suicide-related media material seem to vary with individual vulnerability and with type of media portrayal. Individuals with lower vulnerability experience more emotional reactions when exposed to a film culminating in suicide, but individuals with higher vulnerability experience a rise in suicidal tendencies particularly if they identify with the protagonist who died by suicide. In contrast, portrayals of individual mastery of crisis may have beneficial effects in more vulnerable individuals.

Considerations regarding online methods for suicide-related research and suicide risk assessment

Frequent advances in technology provide new and exciting opportunities for conducting suicide research and suicide risk assessments. However, to the authors' knowledge, best practices for using technology, specifically the Internet, to conduct research protocols involving suicide risk assessments have not been examined. In research contexts, the use of technology for research on suicidal behavior and suicide risk assessment can offer benefits relative to other forms of data collection. These advantages, which include increased validity, feasibility, and efficiency, as well as improvements in data collection and management, are presented. Considerations regarding the implementation of an online system for suicide risk assessment as well as limitations and future directions are discussed.

The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.

Self-Report of Suicidal Thoughts and Behavior vs. School Nurse Evaluations in Dutch High-School Students

Background: Systematic screening to identify adolescents at risk for suicidal behavior is crucial to suicide prevention. Aims: The current practice of screening and follow-up actions taken by school nurses in schools for secondary education in Rotterdam, the Netherlands, was studied. Methods: In Rotterdam, an approach was developed in which, as a standard routine, students are invited to an interview with a school nurse after filling out a youth health survey in classroom setting. This health survey comprised, among other subjects, the Strengths and Difficulties Questionnaire (SDQ) and questions about suicidal thoughts and behaviors. The results from the interviews and the self-report questionnaires of nearly 4000 first-grade students in secondary education were analyzed. Results: The vast majority of invitations were not followed by any action from the school nurse. Also, the majority of students whose self-report led to an “Attention Subject” for the nurse were not considered to be at risk by the nurse. The self-report of recent suicidal thoughts added to the predictive value of emotional distress as measured by the SDQ and other self-report conclusions. Conclusions: This study demonstrates the additional value of self-reported suicidal thoughts for Dutch preventive practices in youth health care.

Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults

Older adults have a disproportionally high rate of completed suicide as compared to the general population. Whereas a large literature has focused on risk factors related to elder suicide, limited research exists on relationships between coping strategies with protective factors against suicide and suicidal ideation in this population. Community-dwelling older adults (N = 108, mean age = 71.5 years, age range = 60-95 years) completed the Coping Orientations to Problems Experienced scale, Reasons for Living inventory, and Geriatric Suicide Ideation Scale (GSIS). Problem- and emotion-focused coping were associated positively with reasons for living and negatively with suicide ideation. Dysfunctional coping was associated positively with suicide ideation, but results did not support the hypothesized negative relationship with reasons for living. Thus, problem- and emotion-focused coping appear to be adaptive, whereas dysfunctional coping appears to be somewhat less related to resilience to suicidal ideation among community-dwelling older adults. Implications of the study are that some coping strategies may serve as protective factors against suicide and that coping strategies should be evaluated as part of a thorough assessment of suicidal risk among older adults. The results also provide some evidence of convergent validity for the recently developed GSIS.

Religiousness, social support and reasons for living in African American and European American older adults: an exploratory study

OBJECTIVES

This study examined the relationship between religiousness, perceived social support, and reasons for living among European American (n = 37; M age = 67.7 years) and African American (n = 35; M age = 71.1 years) older adults, where ethnicity was predicted to behave as a moderator.

METHOD

Community-dwelling participants completed the Brief Multidimensional Measure of Religiousness/Spirituality, the Multidimensional Measure of Perceived Social Support, and the Reasons for Living Inventory.

RESULTS

As expected, high religiousness was associated with more reasons for living. Ethnicity alone did not meaningfully account for variance differences in reasons for living, but significant interactions indicated that the relationship between religiousness and reasons for living was stronger for African Americans, whereas the relationship between social support and reasons for living was stronger for European Americans.

CONCLUSION

The present findings may be valuable for understanding potentially modifiable pathways to suicide resilience in diverse populations of older adults.

Self-reported history of sexual coercion and rape negatively impacts resilience to suicide among women students

A substantial literature has documented that sexual abuse relates to suicidal behaviors but relatively less is known about resilience to suicide, especially cognitive deterrents to suicide. The present study investigated the effects of a history of sexual victimization on reasons for living. Female participants (N = 138; M age = 24.4 years; SD = 7.3 years; range = 18 to 53 years; 79% Caucasian) completed the Sexual Experiences Survey (SES) and the Reasons for Living (RFL) Inventory. According to SES responses, participants were classified into 5 mutually exclusive groups: no victimization, sexual contact, sexual coercion, attempted rape, and rape. Analyses of variance showed that degree of sexual victimization had a significant effect on the RFL Total scale and 2 subscales (Survival and Coping Beliefs; Moral Objections). The general pattern was that mean RFL scores in the no victimization group were significantly higher than the mean scores in the sexual coercion and rape groups. An implication is that having a history of sexual victimization, especially sexual coercion and rape, limits one's later reasons for not committing suicide. Bolstering these modifiable deterrents to suicide should be part of suicide prevention efforts among at-risk women.

A psychometric investigation of the Suicide Status Form II with a psychiatric inpatient sample

We investigated the psychometric validity and reliability of the Suicide Status Form-II (SSF-II) developed by Jobes, Jacoby, Cimbolic, and Hustead (1997). Participants were 149 psychiatric inpatients (108 suicidal; 41 nonsuicidal) at the Mayo Clinic. Each participant completed assessment measures within 24 hours of admission and 48-72 hours later. Factor analyses of the SSF core assessment produced a robust two-factor solution reflecting chronic and acute response styles. The SSF core assessment had good to excellent convergent and criterion validity; pre-post SSF ratings also demonstrated moderate test-retest reliability. The results replicated previous research and show that the SSF-II is psychometrically sound with a high-risk suicidal inpatient sample.

Reasons for living and alcohol use among college students

Heavy alcohol consumption is prevalent on many college campuses and alcohol use has been linked to suicidal behavior. The present study examined reasons for living in 287 college students with varying levels of risk for alcohol-related problems. With the exception of the moral objections subscale of the Reasons for Living Inventory, significant relationships were not detected between alcohol use risk levels and reasons for living. The field is ripe for additional studies examining alcohol use and suicide in the college population, and results will likely lead to improved interventions to decrease the occurrence of suicidal behaviors.

Validation of the Urdu translation of the Beck Scale for Suicide Ideation

This study aimed at developing an Urdu version of the Beck Scale for Suicide Ideation (BSI) for use with Pakistani adolescents and young adults. For this purpose, the English BSI was translated into Urdu and tested for psychometric properties. The analyses were carried out with data from a sample of 904 adolescents and young adults from eight major cities of Pakistan. The Cronbach's alpha of .75 showed that the Urdu version of the BSI has reasonable internal consistency. Principal Component Analysis gave one meaningful component that indicated Active Suicidal Desire. This preliminary validation study of the Urdu version of the BSI showed that it is an acceptable measure to be used with Pakistani adolescents and young adults. The need for further research on suicide in Pakistan is discussed.

An exploration of gender differences on the reasons for living inventory among older adults

This study evaluated gender differences on the Reasons for Living Inventory (RFL) specifically among older adults, a population known to have the highest suicide rate among all age groups, with older men being disproportionately at risk. Community-dwelling women (n = 175; M age = 69.0 years; 81% Caucasian) and men (n = 145; M age = 69.5 years; 76% Caucasian) completed the RFL. Results showed no significant gender differences on the RFL subscales and the total score. The rank order of the subscales was also the same for older men and women. An implication of these findings is that the robust gender differences on the RFL found among younger individuals appear to diminish with advancing age, although it is unclear to what extent older men improve in the reasons for staying alive or older women decline in their reasons for staying alive.