Active suicide ideation is thinking of different ways to die, forming a plan with the means to do so, and the intent to carry it out. Suicidal ideation varies in a range from fleeting thoughts to detailed planning.
Evidenced-Based Assessments for Measuring Suicide Risk
Suicide risk assessments are used to distinguish risk from acute to chronic. An acute risk can be based on present life circumstances or events, whereas a mental health diagnosis or illness determines chronic risk. One model suggested by Bryan and Rudd (2006) that risk level is categorized by baseline, acute, chronic high risk, and chronic high risk with acute exacerbation, and risk level is described as nonexistent, mild, moderate, severe, or extreme.
Other descriptions of risk can be determined by number level. Having a suicide measurement tool readily available can aid clinicians in reporting suicidal ideation. Here are various suicide risk assessments developed over the years:
- SSI/MSSI – The Scale for Suicide Ideation categorizes active suicidal desire, preparation, and passive suicidal desire; the Modified Scale for Suicide Ideation has higher discrimination between groups of suicide ideators and attempters
- SIS – The Suicide Intent Scale considers both the logistics of the suicide attempt and the attempt.
- SABCS – The Suicidal Affect Behavior Cognition Scale is designed to assess current suicidality for clinical, screening, and research purposes. The outcomes show better predictability of future suicidal behaviors and total suicidality over an existing standard.
- SBQ – The Suicide Behaviors Questionnaire is easy to use and quick screening tool for adults though it fails to provide detailed information.
- LOI – Life Orientation Inventory is shown to differentiate between control, depressed, possibly suicidal, and highly suicidal individuals. Though this inventory is useful and, like the validity of the MMPI, it is not readily available.
- RFL – The Reasons for Living Inventory is theoretically based and measures probability on the theory that some factors may mitigate suicidal thoughts.
- NGASR – The Nurses Global Assessment of Suicide Risk looks at items of ‘Evidence of a plan to commit suicide’ and ‘History of psychosis’ and rates each item with its connection with suicide.
- *C-SSRS – The Columbia-Suicide Severity Rating Scale is the most widely used suicide risk tool. It is intended to be used by trained individuals or administrators and determines the presence of suicidal ideation or behavior.
When to Report Suicide Ideation
Start by asking questions. Find out if the individual is in immediate danger of acting on suicidal thoughts. Show compassion and be sensitive and respectful to the topic, though remain direct and acknowledge their feelings.
Questions include asking about suicidal thoughts and feelings and how they are coping. Ask if they have thought about it before or attempted to harm themselves. Ask if they have thoughts about how and when. Another critical question is if they have access to any weapons or items that can be used to harm.
Look for warning signs like preoccupation with death or statements such as “I wish I were dead.” Look into whether they are developing means such as stockpiling medications or purchasing firearms. Are they using language that sounds like hopelessness? Is the individual engaging in substance abuse or increased use? Is the individual changing their routine, giving away their belongings, or saying goodbyes like they won’t see the person again?
If you believe your friend or loved one is showing the above signs listed, or you feel they may be behaving in a manner that makes you believe they may attempt suicide, don’t hesitate, don’t try to handle the situation alone, call to get help.
If You Need Help
- Text 988 Suicide and Crisis Lifeline
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
If you or someone you know is experiencing suicidal ideation, get immediate help from a medical provider or hospital or call 911. If you are with a person who is suicidal, do not leave them alone and remove any items that could be dangerous such as firearms or medications.
Offering Support
You can always encourage your friend or loved one to call a suicide hotline. This can be empowering for them and help them not feel alone. Encouraging treatment to continue to work on managing their symptoms or extinguishing them improves outcomes. You can lend a hand in presenting the treatment options.
Encourage communication with openness in acknowledging their feelings in a non-judgmental and respectful space. Encourage them to refrain from substance use and again make sure to remove any potentially dangerous items in their home.
It’s important to take reporting suicide ideation seriously. Many can feel they may be overreacting, but safety is always the most important. Though you are not responsible for preventing someone from taking their life, intervention can help them see that there are other options.
Resources
- Mayo Clinic https://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707
- Bryan CJ, Rudd MD (February 2006). “Advances in the assessment of suicide risk”. Journal of Clinical Psychology. 62 (2): 185-200
- Beck AT, Kovacs M, Weissman A (April 1979). “Assessment of suicidal intention: the Scale for Suicide Ideation”. Journal of Consulting and Clinical Psychology. 47 (2): 343–52
- Miller IW, Norman WH, Bishop SB, Dow MG (October 1986). “The Modified Scale for Suicidal Ideation: reliability and validity”. Journal of Consulting and Clinical Psychology. 54 (5): 724–5
- Beck RW, Morris JB, Beck AT (April 1974). “Cross-validation of the Suicidal Intent Scale”. Psychological Reports. 34 (2): 445–6.
- Harris KM, Syu JJ, Lello OD, Chew YL, Willcox CH, Ho RH (1 June 2015). “The ABC’s of Suicide Risk Assessment: Applying a Tripartite Approach to Individual Evaluations”. PLOS ONE. 10 (6): e0127442
- Harris KM, Lello OD, Willcox CH (March 2017). “Reevaluating suicidal behaviors: Comparing assessment methods to improve risk evaluations”. Journal of Psychopathology and Behavioral Assessment. 39: 128–139
- Range LM, Knott EC (January 1997). “Twenty suicide assessment instruments: evaluation and recommendations”. Death Studies. 21 (1): 25–58
- Linehan MM, Goodstein JL, Nielsen SL, Chiles JA (April 1983). “Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory”. Journal of Consulting and Clinical Psychology. 51 (2): 276–86
- Cutcliffe JR, Barker P (August 2004). “The Nurses’ Global Assessment of Suicide Risk (NGASR): developing a tool for clinical practice”. Journal of Psychiatric and Mental Health Nursing. 11 (4): 393–400