Toward a Gold Standard for Suicide Risk Assessment

To answer one of the more vexing clinical questions in suicide prevention – which suicide risk assessment measure or set of measures is most helpful in applied settings? – Dr. Peter Gutierrez, PhD, of the Department of Veterans Affairs Rocky Mountain Mental Illness Research Education & Clinical Center (MIRECC) and University of Colorado and Dr. Thomas Joiner, PhD of Florida State University completed a study of over 1,000 active duty service members identified by military treatment providers as being at elevated risk of suicide.

Analyses of data from this study confirmed that four widely used measures are valid and reliable in this clinical population (Gutierrez et al., 2019). No one measure stood out as a gold standard assessment tool, which means clinicians have some flexibility in choosing which measure to use based on their treatment setting and practical concerns. Combining a self-report measure with an interview-based measure provided better information to estimate risk of future thoughts about suicide or suicide attempts. However, no single score or combination of scores is enough to make decisions about whether any specific level of intervention (e.g., inpatient hospitalization) is needed to prevent a negative clinical outcome. Until the promise of recent advances in prediction of clinical outcomes using machine learning and artificial intelligence are fully realized, clinicians are encouraged to rely on the results of this study to guide their decisions about which assessment tools to use and how to interpret the results. Researchers on this team also published a study looking at links between the seriousness of past suicidality and subsequent thoughts about suicide (Hom et al., 2019; Hom, Stanley et al., 2019) and the relationship between specific symptoms of post-traumatic stress disorder and suicide risk (Stanley, Rogers, Hanson, Gutierrez, & Joiner, 2019). Additional analyses are being conducted to fully utilize the wealth of data available from this study.  

References

Gutierrez, P. M., Joiner, T., Hanson, J., Stanley, I. H., Silva, C., & Rogers, M. L. (2019). Psychometric properties of four commonly used suicide risk assessment measures:  Applicability to military treatment settings. Military Behavioral Health, 7(2), 177-184. DOI: 10.1080/21635781.2018.1562390

Hom, M. A., Duffy, M. E., Rogers, M. L., Hanson, J. E., Gutierrez, P. M., & Joiner, T. E. (2019). Examining the link between prior suicidality and subsequent suicidal ideation among high-risk U.S. military service members. Psychological Medicine, 49(13), 2237-2246. DOI:  10.1017/S0033291718003124

Hom, M. A., Stanley, I. H., Duffy, M. E., Rogers, M. L., Hanson, J. E., Gutierrez, P. M., & Joiner, T. E. (2019). Investigating the reliability of suicide attempt history reporting across five measures: A study of U.S. military service members at risk of suicide. Journal of Clinical Psychology, 75(7), 1332-1349. DOI: 10.1002/jclp.22776

Stanley, I. H., Rogers, M. L., Hanson, J. E., Gutierrez, P. M., & Joiner, T. E. (2019). PTSD symptom clusters and suicidal behaviors among high-risk military service members:  A three-month prospective investigation. Journal of Consulting and Clinical Psychology, 87(1), 67-78. doi:10.1037/ccp0000350