The newest rating scale to determine an individual ‘s risk of committing suicide might be at seeing people in most urgent need of assistance much better than other scales that are such, researchers report.
The Columbia-Suicide Severity Rating Scale (C-SSRS) was developed eight years ago and has already been used by clinicians, emergency responders among others. The newest study, appearing online Nov. 8 in the American Journal of Psychiatry, backs its use with new evidence.
Researchers who created the scale weighed its scientific validity from the Columbia Suicide History Form, where the newer scale constructs, and also the Beck Scale for Suicide Ideation, which will be regarded as the gold standard of evaluation tools, said study author Kelly Posner, director of the Center for Suicide Risk Assessment at Columbia University.
A huge difference, Posner said, is that the C-SSRS measures a wider range of behaviors that are potentially suicidal.
“In yesteryear, people would [just] have asked about suicide attempts,” Posner said, adding that “the scale identified a range of behaviours — preparatory behaviors — writing a will, buying a firearm. Now we’re getting at these things. [A person] with only one behavior is eight to 10 times more likely to stop their life.”
“Suicidal ideation” means speaking or thinking about killing yourself. The scale has five levels of ideation, ranging from “wish to be dead” to “active suicidal ideation with specific plan and aim.”
“The Beck scale just looks at ideation and also the Columbia History merely looks at behavior,” while the newer scale rates both, Posner clarified. “It more clearly delineates the kinds of thoughts we have to get at.”
Posner said that assessing suicide risk ought to be part of any routine medical visit.
“I believe it should be, with 50 percent of people [who commit suicide] seeing their primary care physician within the month before they perish,” she said. “It’s a public health crisis, however a preventable public health disaster. We must do better at screening and identifying.”
The test is easy to integrate into busy medical practices, Posner said. “Not merely does it take just a couple of minutes to administer, the screening variation might be a few questions. It reduces false positives also it is less burdensome than not doing anything at all, when you’re asking the correct questions.”
Health Canada, the New York City fire department and public school system, the Baltimore police department, the U.S. National Guard and the Israeli Defense Forces have sought training in using the C SSRS or are already using it, Posner noted.
“I get calls from judges hearing cases. They are using it to reduce unnecessary hospitalizations and interventions — the same manner schools are using it to redirect limited resources where they have to really go,” she said.
To appraise the C SSRS, the survey was given during three studies. One involved 124 youths who had attempted suicide and another involved 237 grownups who went to some hospital emergency department. The third was a trial testing the effectiveness of a medicine for 312 blue youths. The U.S. National Institutes of Health and the American Foundation for Suicide Prevention funded the research.
Lanny Berman, executive director of the American Association of Suicidology, said: “The study is a precious addition to our knowledge of suicide ideation and behaviour. Its findings add weight to our hope that people can satisfactorily quantify, psychometrically, behaviors which are predictive of untoward outcomes we seek to prevent.
“This scale helps in achieving that with those that tell us of their having suicide ideation,” Berman added. “That said, a significant proportion of people who die by suicide deny or do not advise us that they have been thinking of suicide till they participate in deadly self-destructive behaviour, hence we need better tools to assess risk for suicide without relying on conveyed ideation as a starting point for this assessment.”
Said Posner: “Some folks are not going to tell you, no matter what you ask.” But, “a majority of people when asked will be coming and will tell — the point is we’re better identifying those who will and are at greatest risk.”