By using three available scales:
1. Beck's HOPELESSNESS Scale;
2. SBQ-R (Suicide Behavioural Questionnaire); and
3. ATTS (Attitudes Towards Suicide Scale)
Are these sufficient to form a sort of suicidality index? Beck's Hopelessness Scale should have similar tendency as the suicide scales (theoretically).
These are for the matching and comparison with the Level of Religiosity scale.
Bob:
My suggestion is that you first develop an operational definition of "suicidality" (if you have not already done so) and then look at instruments that may "fit" the task of measuring it. I only say this because I don't believe that there is an accepted definition of the term. Like so many other terms, everybody seems to know what it means, but it may mean something different to everybody. BTW those scales would seem good choices.
Best!
Tony
Dear Bob,
I totally agree with Tony's suggestion that you define suicidality. There are many different definitions of this term floating around out there. For some, it means the likelihood a patient will kill themself or the likelihood a patient will be seriously injured as a result of a suicide attempt. While others, myself included, use this as an overarching term to include any suicidality phenomenon.
If you are thinking about using a definition closer to the latter, the scales you mention above do not provide a good overall view of suicidality. Not everyone experiencing suicidality feels hopeless. Nor do they all engage in suicidal behaviors. I have seen no data to support the idea that a patient's attitude towards suicide is in any way relevant in measuring their actual suicidality symptoms. It is even possible that patients will have attitudes supporting suicide even though they are not suicidal themselves (e.g. a patient that has a loved one with ALS might think suicide is an acceptable alternative to slowly suffocating to death).
I always recommend a thorough suicidality scale which includes ideations and behaviors (and if possible, impulses) and does not primarily focus on other items that are not core suicidality phenomena like hopelessness or depression. For example, a patient with schizophrenia that is experiencing a command hallucination to kill themself may not experience either hopelessness or depression, even though they are experiencing suicidality. If you only look at hopelessness or depression this patient will likely not be identified.
The two most comprehensive suicidality scales are the InterSePT Scale for Suicidal Thinking - Plus (ISST-Plus) (and its extension for use in detecting an anti-suicidality efficacy signal the SIBAT) and the Sheehan - Suicidality Tracking Scale (S-STS) (and its extension for use in detecting an anti-suicidality efficacy signal, the S-STS Clinically Meaningful Change Measure [CMCM]). (The ISST-Plus is copyrighted by Dr. Larry Alphs. The S-STS is available from Dr. David Sheehan through HarmResearch.org.) The first linked publication is to a validation study on the core versions of these scales. A validation study on the expanded versions of these scales should start very soon.
Data has shown that a global severity of suicidality may not be a particularly helpful measure because some patients need to minimize the severity of their suicidality in order to cope with it. See the second linked publication.
I hope this helps you decide upon your definition of suicidality and decide which scale(s) to use to measure it.
Best wishes,
Jennifer M. Giddens
Article The Complexity of Assessing Overall Severity of Suicidality:...
Article Comparative Validation of the S-STS, the ISST-Plus, and the ...
Dear Tony and Jennifer, Thanks for your questions. They are very good and "real" questions that I am grappling with now. As you know, this whole thing started when I try to measure whether there is any link between Religion and Suicide. As we don't have good record keeping in Asia for completed suicide, and also I think just by examining Religious Affiliation is not sufficient nowadays due to all the diversities (as compared to Durkheim's days), thus I try to measure on one side, the Level of Religiosity; and the other side Level of Suicidality. It's not for clinical practice purpose. It's supposed to be distributed to, say, 1,000 undergraduate students in a university, in different locations in Asia, to see whether there is any relationship. As we may want to say whether Religiosity (or Level of Religiosity including for the main four religions: Christianity, Islam, Buddhism & Chinese Folk Religions, and Hinduism, in Asia context) is still a Protective Factor against suicide, or there is no relationship at all, I am also still wondering which part of suicidality I should try to measure given that not all scales are 100% and we are trying to get a close proxy to "protective factor" against suicide. It's just a first phase attempt to see what the data say, we may go deeper using qualitative approach if we can find some relationship. This process may also throw some lights on the development of certain scales for the various religions practised in ASIA context.
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