Questions for Suicide Risk Assessment: There, Then and How to Measure?

Background. Diagnostics of suicide risk is an important, but only developing domain in suicidology. Objective. This study aims to clarify the problems and perspectives in this scientific field. The main issues related to measuring this construct are posed and analyzed: the setting, the object of measurement, and the specifics of the available tools. Results. The inference is made about the importance of these variables when choosing a method for measuring suicide risk, as well as the need to combine diagnostics and therapy. Conclusion.The typology for choosing the methods of intervention based on the Narrative Crisis Model of Suicide by I. Galynker is provided. The limitations of the modern diagnostic methods are indicated, the call to rely not so much on various diagnostic tools as on the structured clinical judgment, and also be guided not so much by the presence or absence of suicidal ideation in a respondent, but by understanding their current frustrated needs.

1. Ambrumova A.G. Nepatologicheskie situatsionnye reaktsii v suitsidologicheskoi praktike [Non–pathological situational reactions in suicidological practice] Nauchnye i organizatsionnye problemy suitsidologii Sbornik nauchnykh trudov. [Research and organizational issues of suicidology. Proceedings]. М: MRIP, 1983, pp. 40—51. (In Russ.)
2. Ambrumova A.G., Kalashnikova O.E. Kliniko–psikhologicheskie aspekty samoubiistva [Clinical–psychological aspects of suicide]. Sotsial'naya i klinicheskaya psikhiatriya [Social and Clinical Psychiatry], 1998, vol. 8, no. 4, pp. 53—56. (In Russ.)
3. Antipkina I.V. Metodologiya izmereniya roditel'skoi vovlechennosti v obrazovanie detei: dis. ... kand. nauk v obrazovanii [Methodology of measuring parental involvement in children’s education: Ph.D. diss. (Education)]. Moscow, 2020. 142 p.
4. Bannikov G.S. Struktura krizisnogo sostoyaniya u nesovershennoletnikh: simptomy, svyazannye s vysokim suitsidal'nym riskom [Structure of a crisis state in adolescents: symptoms associated with high suicide risk]. Sotsial'naya i klinicheskaya psikhiatriya [Social and Clinical Psychiatry], 2022, vol. 32, no. 3, pp. 27—37. (In Russ.)
5. Goncharenko A.Yu. et al. Profilaktika suitsidal'nogo povedeniya podrostkov: organizatsionnaya model' mezhvedomstvennogo vzaimodeistviya [Prevention of adolescent suicidal behavior: organizational model of interdepartmental interaction]. In N.V. Semenova (compilation), N.G. Neznanov (ed.) Diagnostika i lechenie psikhicheskikh i narkologicheskikh rasstroistv: sovremennye podkhody. Sbornik metodicheskikh rekomendatsii [Diagnostics and treatment of mental disorders and addiction: contemporary approaches. Guidelines]. / Vyp. 5. Saint Petersburg: KOSTA, 2022, pp. 455—471.
6. Zinchuk M.S. et al. Prognozirovanie suitsidal'nogo riska putem otsenki faktorov rezilentnosti: metodicheskie rekomendatsii [Prognosis of suicide risk by assessment of resilience factors: guidelines]. Moscow: GBUZ NPTs im. Solov'eva DZM. 2022. 25 p.
7. Zotov M.V., Shchelkova O.Yu. Sistemno–situatsionnyi podkhod k prognozirovaniyu riska povedencheskikh rasstroistv [Systemic–situational approach to prognosis of the risk of behavioral disorders]. Vestnik YuUrGU = Bulletin of the South Ural State University, 2011, no. 29, pp. 24—34. (In Russ.)
8. Karpenko O.A. et al. Preduprezhdenie suitsidov u patsientov, nakhodyashchikhsya na lechenii v mnogoprofil'nykh statsionarakh: diagnostika i meditsinskaya taktika. Metodicheskoe posobie [Suicide prevention in patients undergoing treatment in multi–speciality hospitals: diagnostics and medical tactics]. G.P. Kostyuk (ed.) M.: OOO «Izdatel'skii dom KDU». 2020. 34 p. DOI:10.31453/kdu.ru.91304.104
9. Kolachev N.I. et al. Shkala dushevnoi boli R. Kholdena i Shkala beznadezhnosti A. Beka: diagnosticheskie vozmozhnosti dlya predskazaniya suitsidal'nogo riska [The Psychache Scale by R. Holden and Hopelessness Scale by A. Beck: Diagnostic capabilities for predicting suicide risk]. Psikhologicheskie issledovaniya = Psychological Studies. 2023. (in press) (In Russ.)
10. Leont'ev D.A., Rasskazova E.I. Test zhiznestoikosti [Hardiness test]. Moscow: Smysl, 2006. 63 p.
11. Maslov K.A. et al. Sravnitel'noe issledovanie skriningovykh shkal suitsidal'nogo riska (SPS vs. MSPS) [Comparative study of screening suicidal risk scales (SPS vs. MSPS)]. Akademicheskii zhurnal Zapadnoi Sibiri = Academic Journal of West Siberia, 2021, vol. 17, no. 4, pp. 20—22. (In Russ.)
12. Medvedeva T.I. et al. Implitsitnye metody otsenki suitsidal'nogo riska u bol'nykh depressiei [Implicit methods of suicide risk assessment in patients with depression]. In T.P. Klyushnik et al. (ed.) Psikhiatricheskaya nauka v istorii i perspektivy. Materialy Yubileinoi Vserossiiskoi nauchno–prakticheskoi konferentsii s mezhdunarodnym uchastiem, posvyashchennoi 75–letiyu Nauchnogo tsentra psikhicheskogo zdorov'ya [Psychiatric science in history and its perspectives. Proceedings of the All–Russian research–to–practice conference with international participation, commemorated to the 75–years anniversary of the Mental Health Research Center]. Мoscow: MHRS, 2019, pp. 247—251.
13. Men'shikova A.A. et al. Teoriya suitsidal'nogo povedeniya T. Dzhoinera: Adaptatsiya oprosnika mezhlichnostnykh potrebnostei (INQ) [Suicide behavior theory by T. Joiner: Adaptation of the Interpersonal Needs Questionnaire (INQ)]. Rossiiskii psikhiatricheskii zhurnal = Russian Journal of Psychiatry, 2016, no. 2, pp. 51—60. DOI:10.24411/1560–957X–2016–1%25x (In Russ.)
14. Pichikov A.A., Popov Yu.V. Suitsidal'nyi krizis u podrostka: printsipy provedeniya klinicheskogo interv'yu i okazaniya ambulatornoi pomoshchi [A suicidal crisis in adolescents: principles of conducting a clinical interview and providing community–based services]. In N.V. Semenova (compilation), N.G. Neznanov (ed.) Diagnostika i lechenie psikhicheskikh i narkologicheskikh rasstroistv: sovremennye podkhody. Sbornik metodicheskikh rekomendatsii [Diagnostics and treatment of mental disorders and addiction: contemporary approaches. Guidelines]. Vyp. 5, Saint Petersburg: KOSTA, 2022, pp. 343—364.
15. Razuvaeva T.N. Diagnostika lichnosti [Personality Diagnostics]. Shadrinsk: Iset', 1993. 26 p.
16. Chistopol'skaya K.A., Enikolopov S.N. O svyazi stigmy psikhicheskoi bolezni i suitsidal'nogo povedeniya [On the interrelation of mental health stigma and suicidal behavior]. Rossiiskii psikhiatricheskii zhurnal = Russian Journal of Psychiatry, 2018, no. 2, p. 10—18. (In Russ.)
17. Chistopol'skaya K.A., Enikolopov S.N. Osobennosti molodykh lyudei s samopovrezhdeniyami i predshestvuyushchimi popytkami v ostrom suitsidal'nom krizise [Characteristics of young people in acute suicidal crisis with and without non–suicidal self–harm and suicide attempts]. Suitsidologiya = Suicidology, 2019, vol. 10, no. 4, pp. 47—64. DOI:10.32878/suiciderus.19–10–04(37)–47–64 (In Russ., in Eng.)
18. Chistopol'skaya K.A., Enikolopov S.N. «Anna Karenina»: suitsidologicheskii analiz [“Anna Karenina”: a suicidological analysis]. Doktor.Ru, 2022 vol. 21, no. 8, pp. 82—86. DOI:10.31550/1727–2378–2022–21–8–82–86 (In Russ.)
19. Chistopol'skaya K.A. et al. Kontsept «Sochuvstvie k sebe»: rossiiskaya adaptatsiya oprosnika Kristin Neff [The concept of self–compassion: a Russian adaptation of the scale by Kristin Neff]. Kul'turno–istoricheskaya psikhologiya = Cultural–Historical Psychology, 2020, vol. 16, no. 4, pp. 35—48. DOI:10.17759/chp.2020160404 (In Russ., in Eng.)
20. Chistopol'skaya K.A. et al. Adaptatsiya «Oprosnika suitsidal'nogo narrativa» na rossiiskoi vyborke [Adaptation of the Suicidal Narrative Inventory in a Russian sample ]. Suitsidologiya = Suicidology, 2020, vol. 11, no. 4, pp. 76—90. DOI:10.32878/suiciderus.20–11–04(41)–76–90 (In Russ., in Eng.)
21. Chistopol'skaya K.A. et al. Adaptatsiya «Oprosnika suitsidal'nogo krizisa» (SCI–2) na rossiiskoi internet–vyborke vo vremya epidemii COVID–19 [Adaptation of the Suicide Crisis Inventory (SCI–2) in a Russian internet sample during the COVID–19 pandemic]. Suitsidologiya = Suicidology, 2022, vol. 13, no. 1, pp. 88—104. DOI:10.32878/suiciderus.22–13–01(46)–88–104 (In Russ., in Eng.)
22. Chistopol'skaya K.A. et al. Suitsidal'nost' i chuvstvo avtorstva sobstvennoi zhizni: oprosnik M. Linekhan «Prichiny dlya zhizni» [Suicidality and agency: the Reasons for Living Inventory by M. Linehan]. Psikhologicheskaya nauka i obrazovanie = Psychological Science and Education, 2022, vol. 27, no. 3, pp. 65—88. DOI:10.17759/pse.2022270306 (In Russ., in Eng.)
23. Chistopol'skaya K.A. et al. Adaptatsiya Shkal psikhologicheskogo napryazheniya i empiricheskaya proverka teorii suitsidal'nogo napryazheniya J. Zhang na rossiiskoi vyborke [Adaptation of the Psychological Strain Scales and an empirical testing of the Strain Theory of Suicide by J. Zhang in a Russian sample]. Suitsidologiya = Suicidology, 2023, vol. 14, no. 1, pp. 14—37. DOI:10.32878/suiciderus.23–14–01(50)–14–37 (In Russ., in Eng.)
24. Chistopol'skaya K.A. et al. Problema sokrytiya suitsidal'nosti pri obrashchenii k pomogayushchim spetsialistam [The problem of non–disclosure of suicidality to helping professionals]. In N.V. Zvereva, I.F. Roshchina (eds.) Polyakovskie chteniya 2023. «Tret'i Polyakovskie chteniya po klinicheskoi psikhologii (k 95–letiyu Yu.F. Polyakova)». Sbornik materialov Vserossiiskoi nauchno–prakticheskoi konferentsii s mezhdunarodnym uchastiem (23–24 marta 2023 g.) [Poliakov’s Readings 2023. “3rd Poliakov’s Readings in clinical psychology (Commemorated to Yu.F. Poliakov’s 95–years anniversary)”. Proceedings of the All–Russian research–to–practice conference with international participation (March, 23–24, 2023)]. Moscow: MSUPE, 2023, pp. 619—624.
25. Shneidman E. Dusha samoubiitsy [The Suicidal Mind]. Moscow: Smysl, 2001. 315 p.
26. Ahmedani B.K. et al. Health care contacts in the year before suicide death. Journal of General Internal Medicine, 2014, vol. 29, no. 6, pp. 870—877. DOI:10.1007/s11606–014–2767–3
27. Baumeister R. Suicide as escape from self. Psychological Review, 1990, vol. 97, pp. 90—113. DOI:10.1037/0033–295X.97.1.90
28. Blanchard M., Farber B.A. “It is never okay to talk about suicide”: Patients’ reasons for concealing suicidal ideation in psychotherapy. Psychotherapy Research, 2020, vol. 30, no. 1, pp. 124—136. DOI:10.1080/10503307.2018.1543977
29. Bloch–Elkouby S. et al. The revised Suicide Crisis Inventory (SCI–2): Validation and assessment of prospective suicidal outcomes at one month follow–up. Journal of Affective Disorders, 2021, vol. 295, pp. 1280—1291. DOI:10.1016/j.jad.2021.08.048
30. Branley–Bell D. et al. Distinguishing suicide ideation from suicide attempts: Further test of the integrated motivational–volitional model of suicidal behavior. Journal of Psychiatric Research, 2019, vol. 117, pp. 100—107. DOI:10.1016/j.jpsychires.2019.07.007
31. Bryan C.J., Rudd M.D. Advances in the assessment of suicide risk. Journal of Clinical Psychology: In Session, 2006, vol. 62, no. 2, pp. 185—200. DOI:10.1002/jclp.20222
32. Carter G. et al. Predicting suicidal behaviours using clinical instruments: systematic review and meta–analysis of positive predictive values for risk scales. The British Journal of Psychiatry, 2017, vol. 210, pp. 387—395. DOI: 10.1192/bjp.bp.116.182717
33. Fazel S. et al. The prediction of suicide in severe mental illness: development and validation of a clinical prediction rule (OxMIS). Translational Psychiatry, 2019, vol. 9, pp. 98. DOI:10.1038/s41398–019–0428–3
34. Franklin J.C. et al. Risk factors for suicidal thoughts and behaviors: a meta–analysis of 50 years of research. Psychological Bulletin, 2017, vol. 143, no. 2, pp. 187—232. DOI:10.1037/bul0000084
35. Galynker I. The suicidal crisis: Clinical guide to the assessment of imminent suicide risk. 2nd edition. New York, NY: Oxford University Press, 2023. 537 p.
36. Hawton K. et al. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. The Lancet, 2022, vol. 9, no. 11, pp. 922—928. DOI:10.1016/S2215–0366(22)00232–2
37. Henden J. Preventing suicide: The solution focused approach. 2nd ed. Chichester, UK: Wiley–Blackwell, 2017. 336 p.
38. Horowitz L.M. et al. Validation of the Ask Suicide–Screening Questions for adult medical inpatients: A brief tool for all ages. Psychosomatics, 2020, vol. 61, no. 6, pp. 713—722. DOI:10.1016/j.psym.2020.04.008
39. Høyen K.S. et al. Non–disclosure of suicidal ideation in psychiatric inpatients: Rates and correlates. Death Studies, 2022, vol. 46, no. 8, pp. 1823—1831. DOI:10.1080/07481187.2021.1879317
40. Jobes D.A. et al. Clinical improvements of suicidal outpatients: Examining suicide status form responses as predictors and moderators. Archives of Suicide Research, 2009, vol. 13, pp. 147—159. DOI:10.1080/13811110902835080
41. Karsen E. et al. Impact of the abbreviated suicide crisis syndrome checklist on clinical decision making in the emergency department. The Journal of Clinical Psychiatry, 2023, vol. 84, no. 3, pp. 46878. DOI:10.4088/JCP.22m14655
42. Kene P., Yee E.T., Gimmestad K.D. Suicide assessment and treatment: gaps between theory, research, and practice. Death Studies, 2019, vol. 43, no. 3, pp. 164—172. DOI:10.1080/07481187.2018.1440034
43. Kleiman E.M., Glenn C.R., Liu R.T. The use of advanced technology and statistical methods to predict and prevent suicide. Nature Review Psychology, 2023. DOI:10.1038/s44159–023–00175–y
44. Kyron M.J. et al. Allowing nondisclosure in surveys with suicide content: Characteristics of nondisclosure in a national survey of emergency services personnel. Psychological Assessment, 2020, vol. 32, no. 12, pp. 1106—1117. DOI:10.1037/pas0000949
45. Large M.M. The role of prediction in suicide prevention. Dialogues in Clinical Neuroscience, 2018, vol. 20, no. 3, pp. 197—205. DOI:10.31887/DCNS.2018.20.3/mlarge
46. McHugh C. et al. Association between suicidal ideation and suicide: meta–analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych Open, 2019, vol. 5, no. 2, e18, pp. 1—12. DOI:10.1192/bjo.2018.88
47. McGillivray L. et al. Non–disclosing youth: a cross–sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional. BMC Psychiatry, 2022, vol. 22, pp. 3. DOI: 10.1186/s12888–021–03636–x
48. Moreno M., Gutierrez–Rojas L., Porras–Segovia A. Implicit cognition tests for the assessment of suicide risk: a systematic review. Current Psychiatry Reports, 2022, vol. 24, pp. 141—159. DOI:10.1007/s11920–022–01316–5
49. O’Connor R.C., Kirtley O.J. The integrated motivational–volitional model of suicidal behavior. Philosophical Transactions of the Royal Society B: Biological Sciences, 2018, vol. 373, pp. 20170268. DOI:10.1098/rstb.2017.0268
50. OECD. PISA 2012 Technical Report. Paris: OECD Publishing, 2014. 472 p.
51. Pichikov A., Popov Yu. Problems with suicidal behavior prevention in adolescents: a narrative literature review. Consortium Psychiatricum, 2022, vol. 3, no. 2, pp. 5—14. DOI:10.17816/CP166
52. Posner et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 2011, vol. 168, no. 12, pp. 1266—1277. DOI:10.1176/appi.ajp.2011.10111704
53. Retterstøl N. Suicide: A European Perspective. Cambridge: Cambridge University Press, 1993. 273 p.
54. Ringel E. Das Leben wegwerfen? Reflexionen über Selbstmord. [Throwing away Life? Reflections on Suicide]. Wien: Herder, 1978. 282 p. (In Germ.)
55. Rogers M.L., Hom M.A., Joiner T.E. Differentiating acute suicidal affective disturbance (ASAD) from anxiety and depression symptoms: A network analysis.  Journal of Affective Disorders, 2019, vol. 250, pp.333—340. DOI:10.1016/j.jad.2019.03.005
56. Rudd M.D. Fluid vulnerability theory: a cognitive approach to understanding the process of acute and chronic suicide risk. In T.E. Ellis (ed.) Cognition and Suicide: Theory, Research, and Therapy. Washington, DC: American Psychological Association. 2006. P. 355—368.
57. Saab M.M. et al. Suicide and self–harm risk assessment: a systematic review of prospective research. Archives of Suicide Research, 2022, vol. 26, no. 4, pp. 1645—1665. DOI:10.1080/13811118.2021.1938321
58. Simpson S.A. et al. New data on suicide risk assessment in the emergency department reveal the need for new approaches in research and clinical practice. Psychological Medicine, 2021, vol. 53, no. 3, pp. 1122—1123. DOI:10.1017/S0033291721001653
59. Shneidman E.S. Suicidology: Contemporary Developments. New York: Grune & Stratton, 1976. 586 p.
60. Tyndal T., Zhang I., Jobes D.A. The collaborative assessment and management of suicidality (CAMS) stabilization plan for working with patients with suicide risk. Psychotherapy, 2022, vol. 59, no. 2, pp. 143—149. DOI:10.1037/pst0000378
61. Vespa A., Galynker I., Chistopol'skaya K.A. Emotsional'nyi otklik klinitsista na patsientov s suitsidal'nym riskom: obzor literatury [Clinician emotional response to patients at risk of suicide: a review of the extant literature]. Suitsidologiya = Suicidology. 2021, vol. 12, no. 1, pp. 47—63. DOI:10.32878/suiciderus.21–12–01(42)–47–63 (In Rus., in En.)
62. Whiting D., Fazel S. How accurate are suicide risk prevention models? Asking the right questions for clinical practice. Evidence–Based Mental Health, 2019, vol. 22, no. 3, pp. 125—128. DOI:10.1136/ebmental–2019–300102
63. Yaseen Z.S. et al. Predictive validity of proposed diagnostic criteria for the suicide crisis syndrome: an acute presuicidal state. Suicide and Life–Threatening Behavior, 2019, vol. 49, no. 4, pp. 1124—1135. DOI:10.1111/sltb.12495
64. Zortea T. et al. Understanding and managing suicide risk. British Medical Bulletin, 2020, vol. 134, no. 1, pp. 73—84. DOI: 10.1093/bmb/ldaa013