Psychometric Characteristics of the Adult Suicidal Ideation Questionnaire in College Students

There is a growing concern for identifying individuals at risk for suicidal behaviors. Suicidal ideation, that is, the thoughts and cognitions one has about suicidal behaviors and intent, may be considered a primary marker for the risk of more serious suicidal behaviors. This investigation examined the reliability and validity of the Adult Suicidal Ideation Questionnaire (ASIQ; Reynolds, in press-a), a 25-item self-report suicidal ideation measure designed for adults. Subjects were 474 college students from two Midwestern universities. Results indicated high internal consistency (rα = .97) and test-retest (r[sub tt] = .86) reliability of the ASIQ with college students. Significant correlations (rs = .38 to .60) were found with measures of depression, hopelessness, anxiety, and self-esteem. For the total sample, a multiple correlation of .67 was found between the ASIQ, the independent variables just noted, and history of prior suicide attempt. Factor analysis of the ASIQ produced a four-factor solution. Psychometric support for the utilization of the ASIQ in clinical and research settings is presented and discussed. There is a growing concern for identifying individuals at risk for suicidal behaviors. Suicidal ideation, that is, the thoughts and cognitions one has about suicidal behaviors and intent, may be considered a primary marker for the risk of more serious suicidal behaviors. This investigation examined the reliability and validity of the Adult Suicidal Ideation Questionnaire (ASIQ; Reynolds, in press-a), a 25-item self-report suicidal ideation measure designed for adults. Subjects were 474 college students from two Midwestern universities. Results indicated high internal consistency (rα = .97) and test-retest (r[sub tt] = .86) reliability of the ASIQ with college students. Significant correlations (rs = .38 to .60) were found with measures of depression, hopelessness, anxiety, and self-esteem. For the total sample, a multiple correlation of ...     

Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students

There is a growing concern for identifying individuals at risk for suicidal behaviors. Suicidal ideation, that is, the thoughts and cognitions one has about suicidal behaviors and intent, may be considered a primary marker for the risk of more serious suicidal behaviors. This investigation examined the reliability and validity of the Adult Suicidal Ideation Questionnaire (ASIQ; Reynolds, in press-a), a 25-item self-report suicidal ideation measure designed for adults. Subjects were 474 college students from two Midwestern universities. Results indicated high internal consistency (r alpha = .97) and test-retest (rtt = .86) reliability of the ASIQ with college students. Significant correlations (rs = .38 to .60) were found with measures of depression, hopelessness, anxiety, and self-esteem. For the total sample, a multiple correlation of .67 was found between the ASIQ, the independent variables just noted, and history of prior suicide attempt. Factor analysis of the ASIQ produced a four-factor solution. Psychometric support for the utilization of the ASIQ in clinical and research settings is presented and discussed.     

Physical and Sexual Victimization Predicts Suicidality among Women in Prison: Understanding Ethnic and Trauma-Specific Domains of Risk

Few studies have addressed the association between specific forms of trauma and suicidality among incarcerated women. This study examined domains of trauma as predictors of suicidality, and also evaluated ethnicity as a moderator of the association between physical and sexual victimization and suicidality. Participants were 224 treatment-seeking incarcerated women who completed self-report measures of trauma exposure, suicidal behavior, and ethnicity. Women in this sample reported significant histories of trauma exposure and suicidal behavior, and physical and sexual victimization significantly predicted suicidality. Ethnicity moderated this association such that there was a significant positive association between victimization and suicidality for European-American women; however, this association was not statistically significant for ethnic minority women. These findings demonstrate the specific risk conferred by physical and sexual victimization and European-American ethnicity among women in prison.     

Risk and Protective Factors that Distinguish Adolescents Who Attempt Suicide from Those Who Only Consider Suicide in the Past Year

Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population‐based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self‐injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same‐sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.     

Reevaluating Suicidal Behaviors: Comparing Assessment Methods to Improve Risk Evaluations

This study examined suicide assessment validity by comparing methods of measuring current risk associated with past suicidal behaviors. Three independent samples (Ns = 359, 1007, and 713; aged 18–76 years) all included participants covering a broad spectrum of suicidality. Information theory, item response theory, general linear modeling, and linear regression modeling tested seven competing methods/models of assessing past suicidal behaviors in relation to current suicidality. In contrast to contemporary theories, ANOVA results showed suicide plans can indicate higher risk than suicide attempts when intent to die is higher. Contrary to popular practice, evidence demonstrated that defining risk by suicide ideation (yes/no), attempts or serious attempts (yes/no), are false dichotomies, were the least valid models tested, and failed to explain substantial explainable variance in suicidality/risk. A newly proposed model, differentiating behaviors with or without intent to die, was the most efficacious dichotomous method. However, as predicted, continuous variables were superior to dichotomous. The proposed suicidal barometer model (SBM) exhibited robust evidence as the best available model for evaluating suicidal behaviors in all samples (100 % probability), explaining 47–61 % of suicidality variance and provided incremental improvement in risk evaluations. Findings were consistent by sample, sex, age-group, ethnicity, and psychiatric history. This study, and related evidence, demonstrate that there is a clear and present need for updating measures, clinical training and core competencies, for valid assessment and risk formulation.     

Single-Sign Rorschach Suicide Indicators: A Validity Study Using a Depressed Inpatient Population

This study attempted to test the validity of using single responses on the Rorschach as indicators of current suicidal risk. Forty-one depressed inpatients were administered the Rorschach along with a concurrent measure of depression and suicidality. Appelbaum and Holzman's (1962) color-shading sign was found to be related to low suicidal risk, whereas Blatt and Ritzler's (1974) transparency sign was found to be unrelated to current suicidal risk, but still related to a past history of suicide attempts. Patients who saw these signs while depressed were also likely to see them when recovered, suggesting that the signs may indicate a "suicidal personality" who may or may not be in any immediate danger of committing suicide.     

Single-sign Rorschach suicide indicators: a validity study using a depressed inpatient population

This study attempted to test the validity of using single responses on the Rorschach as indicators of current suicidal risk. Forty-one depressed inpatients were administered the Rorschach along with a concurrent measure of depression and suicidality. Appelbaum and Holzman's (1962) color-shading sign was found to be related to low suicidal risk, whereas Blatt and Ritzler's (1974) transparency sign was found to be unrelated to current suicidal risk, but still related to a past history of suicide attempts. Patients who saw these signs while depressed were also likely to see them when recovered, suggesting that the signs may indicate a "suicidal personality" who may or may not be in any immediate danger of committing suicide.     

High school bullying as a risk for later depression and suicidality

This is the first study to examine whether high school students experiencing frequent bullying behaviors are at risk for later depression and suicidality. A total of 236 students who reported frequent bullying behavior without depression or suicidality during a suicide screening were interviewed 4 years later to reassess depression, suicidal ideation, attempts, substance problems, and functional impairment and were compared to at‐risk youth identified during the screen, including 96 youth who also experienced bullying behavior. Youth who only reported frequent bullying behaviors (as bullies, victims, or both) did not develop later depression or suicidality and continued to have fewer psychiatric problems than students identified as at‐risk for suicide. Students who experienced bullying behaviors and depression or suicidality were more impaired 4 years later than those who had only reported depression or suicidality. Thus, assessment of bullying behaviors in screening protocols is recommended.     

Low self‐esteem,entrapment, and reason for living: A moderated mediation model of suicidal ideation

Adolescent suicidal ideation has become a top public health concern. It is thus significant to explore both risk and protective factors of adolescent suicidal ideation. The present study tested a moderated mediation model of suicidal ideation in a sample of Chinese adolescents. Chinese adolescents of 1074 (54.2% females, aged between 11 and 18 years) completed questionnaires assessing self‐esteem, entrapment, reason for living, and suicidal ideation. We found that entrapment mediated the association between low self‐esteem and suicidal ideation. The association between entrapment and suicidal ideation was moderated by reason for living. Findings of this study may expand our understanding of the development of suicidal ideation, and facilitate future research exploring the interplay of risk and protective factors of suicidality. Clinical implications of these findings were also discussed.     

Fewer reasons for staying alive when you are thinking of killing yourself: The brief reasons for living inventory

The Linehan Reasons for Living Inventory is a 48-item scale on which respondents rate how important each item would be for living if suicide were contemplated. The inventory possesses good psychometric properties and can distinguish suicidal from nonsuicidal people among shoppers, psychiatric inpatients, college students, and adolescents. As its length limits its utility in many institutional and screening settings, the purpose of this study was (1) to develop a brief form of the Reasons for Living Inventory appropriate for clinical use and (2) to examine the predictive validity of this brief measure, named the Brief Reasons for Living Inventory (BRFL), to distinguish suicidal from nonsuicidal prison inmates. Results indicate that the brief form was as good as either the Beck Depression Inventory or the Beck Hopelessness Scale at predicting suicidality in this population. Further study is needed to validate the BRFL with different institutionalized and other populations as well as to assess its ability to discriminate suicide ideators from those engaging in overt suicidal behavior.Support for this project was provided in part by the New York State Office of Mental Health Bureau of Forensic Services and the New York State Department of Correctional Services.     

Psychosocial treatment of depression and suicidality in adolescents

Depression is a common disorder among adolescents and is associated with a high risk of suicide. Suicide is the third leading cause of death among adolescents in the United States. Currently, there are only two evidence-based psychotherapies for adolescence depression: cognitive-behavioral therapy and interpersonal psychotherapy. Furthermore, psychosocial interventions that specifically target suicidal behavior in adolescents are even fewer in number than treatments for depression. This article will review the psychosocial interventions for depression and suicidality in adolescents and will describe a recently developed treatment that is under study for depressed suicidal adolescents.     

Psychometric properties of the Chinese version of the End-of-Life Decision-Making and Staff Stress Questionnaire

Background/objectiveThe goal of this study is to establish a Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire to assess its reliability and validity.MethodA sample of 119 Intensive Care Unit physicians and 485 nurses in China completed the questionnaire, along with questionnaires assessing motional exhaustion subscale, Stress Overload Scale, and other variables associated with end-of-life decision.ResultsSeven factors obtained via exploratory factor analysis could explain 70.61% of the total variance. Confirmatory factor analysis demonstrated an acceptable model fit with Root Mean Square Error of Approximation (RMSEA) being .078 and Standardized Root Mean Square Residual (SRMR) being .066. Validity evidence based on relationships with other variables was provided by positive or negative correlations between the questionnaire subscales and emotional exhaustion, stress overload, and other variables associated with end-of-life decision. The average content validity index was .96. The Cronbach’s α and test–retest reliability was outstanding.ConclusionsThe Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire is a reliable and valid instrument for measuring the facilitators and hinders to facilitate the end-of-life decision-making, communication and the associated pressure perceived by relevant Intensive Care Unit medical staff among the Chinese population.     

Health-risk behaviors and suicidal ideation: a preliminary study of cognitive and developmental factors

Various theorists have suggested that unhealthy behaviors such as cigarette smoking and problem drinking may be subtle forms of suicidality. Consistent with this view, prior research has shown an association between health risk behaviors and suicidal ideation. In the present study we examined relationships among suicidal ideation, health-related attitudes and behaviors, and adverse childhood events. We hypothesized that unhealthy attitudes, perhaps shaped by adverse childhood events, would help explain the association between suicidal phenomena and unhealthy behaviors. Three-hundred eighteen college students completed surveys covering health risk behaviors, depression, suicidal ideation, and health-related attitudes. Results supported the hypothesized associations among these variables. However, contrary to our hypotheses, the association between suicidal ideation and health-compromising behaviors was limited largely to substance-related behaviors. Moreover, the association between suicidal ideation and health-related attitudes was mediated by depression. Adverse childhood events were associated with health-related attitudes, but this relationship was mediated by depression. These results are less suggestive of the notion of unhealthy behaviors as subtle suicidality than a model in which suicidality associates specifically with psychopathological states such as depression and substance abuse. Implications for treatment and prevention programs are discussed.     

Psychological factors in deliberate self-harm as seen in a urban African population in Uganda: a case-control study

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patients admitted to the participating hospitals for non-recurrent medical conditions. Hopelessness, global psychological distress, and state anger, but not depression, were significantly associated with DSH after controlling for other factors. Both depression and hopelessness were significantly associated with suicidal intent independent of each other. Differences were observed on the psychological factors associated with suicidal intent in the different age/sex groups and in the depressed/nondepressed group. Interventions for DSH in this population should include treatments for both depression and hopelessness. This study further raises questions about the universality of the structural relationship among depression, hopelessness, and suicidality.     

Peer victimization, depression, and suicidiality in adolescents

The association between specific types of peer victimization with depression, suicidal ideation, and suicide attempts among adolescents was examined. A self-report survey was completed by 2,342 high-school students. Regression analyses indicated that frequent exposure to all types of peer victimization was related to high risk of depression, ideation, and attempts compared to students not victimized. Infrequent victimization was also related to increased risk, particularly among females. The more types of victimization the higher the risk for depression and suicidality among both genders. Specific types of peer victimization are a potential risk factor for adolescent depression and suicidality. It is important to assess depression and suicidality among victimized students in order to develop appropriate intervention methods.     

Pathological gambling and suicidality: an analysis of severity and lethality

Pathological gambling represents a major public health issue. Risk factors for suicide such as major depression, substance abuse, marital breakdown, unemployment, financial crises, and legal difficulties are commonly found in populations of pathological gamblers. The objective of this study was to systematically investigate the nature of suicidal behavior among treatment-seeking pathological gamblers and its relationship to gambling characteristics and depression. Indices of suicidality were assessed in a sample of 85 treatment-seeking diagnosed pathological gamblers. High rates of suicidal ideation, suicidal plans, and attempts were found; however, no clear relationship was observed between suicidality and indices of gambling behavior. Depression rather than gambling specific characteristics, marital difficulties, or the presence of illegal behaviors appear to be related to the risk of suicidality.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.     

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.     

Assessment of acquired capability for suicide in clinical practice

The Interpersonal Psychological Theory of suicide proposes that the interaction between Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide (ACS) predicts proximal risk of death by suicide. Instruments to assess all three constructs are available. However, research on the validity of one of them, the acquired capability for suicide scale (ACSS), has been limited, especially in terms of its clinical relevance. This study aimed to explore the utility of the different versions of the ACSS in clinical assessment. Three versions of the scale were investigated, the full 20-item version, a 7-item version and a single item version representing self-perceived capability for suicide. In a sample of patients recruited from a clinic specialising in the treatment of suicidality and in a community sample, all versions of the ACSS were found to show reasonable levels of reliability and to correlate as expected with reports of suicidal ideation, self-harm, and attempted suicide. The item assessing self-perceived acquired capacity for suicide showed highest correlations with all levels of suicidal behaviour. However, no version of the ACSS on its own showed a capacity to indicate suicide attempts in the combined sample. It is concluded that the versions of the scale have construct validity, but their clinical utility is limited. An assessment using a single item on self-perceived ACS outperforms the full and shortened versions of ACSS in clinical settings and can be recommended with caution for clinicians interested in assessing this characteristic.     

Characteristics of Suicidality Among Adolescents

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.