When a psychiatrist, emergency department worker, or other clinician deals with an emotionally troubled patient, one of the most important questions to ask is, “How great is the risk that this person will engage in some form of suicidal behavior in the near future?” Unfortunately, although suicide researchers have learned a great deal about the various factors that make suicide either more or less likely and have developed and tested theories about why people die by suicide, there is still no clear-cut best way to gauge the likelihood of near-term suicidal behavior in a given individual. Generally speaking, the best indication of a person’s future suicidal behavior is provided by his or her past suicidal behavior—having attempted suicide once makes a person significantly more likely to attempt suicide in the future, for instance, and multiple past attempts indicate a highly elevated future risk—but this applies mainly to lifetime risk and offers little information about the individual’s risk over, say, the next few months.
Thus it would be extremely valuable for clinicians who deal with potentially suicidal patients if they had some accurate and efficient way to assess the imminent risk of suicidal behavior. Ideally, such a measure should be relatively easy for clinicians to learn how to administer, and it should be designed for use in a clinical setting, not just academic research laboratories.
To identify such a “gold standard” for clinical suicide risk assessment, Thomas Joiner of Florida State University and Peter Gutierrez of the Denver VA Medical Center are testing four widely used measures against each other to determine which measure or combination of measures offers the most accurate prediction of suicide-related behaviors three months into the future. The four tools are the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, Suicidal Behaviors Questionnaire–Revised, and the Beck Scale for Suicide Ideation. All four of these measures have been shown to be reliable and valid in clinical settings, they are sensitive to a broad range of suicidal behaviors, and they have been judged likely to predict future attempts at suicide. The four measures will be tested over a period of three years in a total of 900 personnel from three military installations, each of whom was either seeking services from or was referred to inpatient psychiatry, outpatient behavioral health services, or an emergency department because of concerns about suicide risk. Each of the 900 will be administered all four assessments, and each will be given a follow up three months later to determine if he or she had engaged in any self-harm behaviors since the initial assessment. With that information in hand, it should be possible to identify a gold-standard measure that clinicians can use in assessing the likelihood of imminent suicidal behaviors in their patients.