Beck Suicide Intent Scale Research Articles

Suicidal Intent Among Young Suicides in Rural China

To understand psychometric characteristics of Beck Suicide Intent Scale (SIS) and different characteristics of suicides between high and low intent in Chinese culture. Data of 386 suicides and 416 living controls aged 15–34 years were used to analyze psychometric characteristics of SIS with 6 items. SIS with 6 items had high reliability and validity. Different characteristics were found between suicides with high intent and low intent. Hopelessness, depression, impulsivity, and approach coping skill were common factors of suicide with high and low intent. Education years, marriage, social support, and mental disorders were specific factors of suicide with low intent. High intent suicides had different characteristics from low intent suicides. SIS with 6 items is suitable for use in young rural China.

Why do people choose charcoal burning as a method of suicide? An interview based study of survivors in Taiwan

BackgroundMarked increases in the incidence of charcoal burning suicide have contributed to Taiwan's rising suicide rate in the past decade. To assess possible opportunities for intervention, we have compared survivors of suicide attempts by charcoal burning with people who ingested poisons. MethodsWe interviewed a consecutive series of suicide attempters by charcoal burning (n=37) and self-poisoning (n=38) admitted to Taipei Veterans General Hospital (TVGH) between January 2009 and March 2010. Interviews included the Structured Clinical Interview of DSMIV (SCID) and Beck Suicide Intent Scale. ResultsCompared to people who ingested medicines/poisons, charcoal burning suicide attempters were less likely to have a pre-existing physical illness or contact with psychiatric services prior to the attempt and more likely to be employed. Charcoal burning suicide attempters had higher levels of suicide intent (mean score 20.1) compared to people ingesting poisons (mean score 13.5) (p<0.001) and were considerably more likely to report that their choice of method was influenced by the media (87% vs. 8%), particularly the portrayal of the method as a peaceful way of dying. Charcoal burning suicides were less impulsive. LimitationsThe study sample was limited to a single hospital. ConclusionsSurvivors of suicide attempts by charcoal burning have high levels of intent and low levels of psychiatric contact indicating they may be more difficult to prevent than suicides by self-poisoning. Encouraging responsible media reporting of suicide and restricting the availability of charcoal may be the most promising approaches to preventing these deaths.

Suicide Intent Scale in the prediction of suicide

To assess the predictive value of the Suicide Intent Scale in patients with high suicide risk. The secondary aim was to assess if the use of the factors of the Suicide Intent Scale may offer a better predictive value in suicide risk detection. Finally a shorter version of the scale was created after an item analysis. Eighty-one suicide attempters were assessed with the Beck's Suicide Intent Scale (SIS). All patients were followed up for cause of death. Receiver-operating characteristic (ROC) curves and tables were created to establish the optimal cut-off values for SIS and SIS factors to predict suicide. Seven patients committed suicide during a mean follow up of 9.5 years. The major finding was that mean SIS scores distinguished between suicides and survivors. The positive predictive value was 16.7% and the Area Under Curve (AUC) was 0.74. Only the planning subscale reached statistical significance. Four items were used to test a shorter version of the SIS in the suicide prediction. The positive predictive value was 19% and the AUC was 0.82. The Suicide Intent Scale is a valuable tool in clinical suicide risk assessment, a shorter version of the scale may offer a better predictive value.

Suicide in patients treated for obsessive–compulsive disorder: A prospective follow-up study

Background To describe the occurrence of persistent suicidal ideation and suicide attempts in a sample of obsessive–compulsive patients followed-up prospectively during 1 to 6 years, and to determine the existence of predictors of suicide behavior. Method Two hundred and eighteen outpatients with DSM-IV OCD, recruited from a specialized OCD Unit in Barcelona, Spain, between February 1998 and December 2007, were included in the study. Suicide ideation was assessed by item 3 of the Hamilton Depression Rating Scale. Suicide attempts were evaluated by the Beck Suicide Intent Scale. Patients with and without persistent suicidal thoughts and suicide attempters and non-attempters were compared on sociodemographic and clinical variables. A Cox proportional hazards regression analysis was used to estimate potential predictors of suicide. Results Patients completed a mean follow-up period of treatment of 4.1 years (SD: 1.7; range: 1–6 years). During this period, eighteen patients (8.2%) reported persistent suicidal ideation, two patients (0.91%) committed suicide and 11 (5.0%) attempted suicide. Being unmarried, presenting higher basal scores in the HDRS, current or previous history of affective disorders and symmetry/ordering obsessions were independently associated with suicidal behaviors. Limitations Patients were recruited from a specialized OCD clinic and received exhaustive treatment. Influence of variables including social support, life events, hopelessness and substance abuse/dependence was not assessed. Conclusions Suicide behavior is not a highly common phenomenon in OCD, but it should not be disregarded, especially in unmarried patients, with comorbid depression and symmetry/ordering obsessions and compulsions, who appear to be at a greater risk for suicide acts.

Specific Features of Suicidal Behavior in Patients With Narcissistic Personality Disorder

Suicidal behavior is a clinically significant but underestimated cause of mortality in narcissistic personality disorder. Currently, there are no reliable estimates of suicidal behavior for this population. The main objective of this study was to test whether or not suicide attempters diagnosed with narcissistic personality disorder are different in terms of impulsivity and expected lethality from suicide attempters with other cluster B personality disorders. In a sample of 446 suicide attempters, patients with cluster B personality disorder diagnoses (n = 254) as assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), version of the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were compared in terms of expected lethality and impulsivity (measured by the Beck Suicidal Intent Scale and the Barratt Impulsiveness Scale, respectively). The subjects were admitted to the emergency departments of the Ramón y Cajal Hospital and the Fundación Jiménez Diaz University Hospital in Madrid, Spain, between January 1999 and January 2003. Suicide attempts of subjects diagnosed with narcissistic personality disorder had higher expected lethality than those of subjects without narcissistic personality disorder (t = -4.24, df = 439, P < .001). There were no differences in expected lethality of the attempts when comparing subjects with and without histrionic personality disorder (t = 0.28, df = 439, P = .795), antisocial personality disorder (t = 0.66, df = 439, P = .504), and borderline personality disorder (t = 1.13, df = 439, P = .256), respectively. Suicide attempters diagnosed with narcissistic personality disorder did not significantly differ from suicide attempters without narcissistic personality disorder in terms of impulsivity measures (t = -0.33, df = 442, P = .738), while suicide attempters diagnosed with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder were significantly more impulsive than suicide attempters without these diagnoses (t = -3.96, df = 442, P < .001; t = -3.88, df = 442, P < .001; and t = -7.44, df = 442, P < .001, respectively). Narcissistic personality disorder seems to be a distinct group among cluster B personality disorders with regard to suicidal behavior. In contrast to suicide attempters with other cluster B personality disorders, suicide attempters diagnosed with narcissistic personality disorder are less impulsive and have suicide attempts characterized by higher lethality. These distinctions may offer a basis for targeted therapies aimed at decreasing suicidal risk in patients with narcissistic personality disorder.

Cerebrospinal fluid monoamine metabolites and suicide

Prospective studies of the serotonergic system and suicide report that low 5-hydroxyindolacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) and a history of attempted suicide predict suicide risk. Low CSF homovanillic acid (HVA) is reported to be associated with past and future lethality of suicide attempts but not with suicide. The interrelationships between monoamine metabolites, violent method, suicide intent and lethality of suicidal behaviour are complex. We hypothesized that CSF 5-HIAA and HVA levels are related to suicide intent, violence and lethality of suicidal behaviour. Fifteen male suicide attempters admitted to a psychiatric ward at the Karolinska University Hospital and eight healthy male volunteers were submitted to lumbar puncture and CSF 5-HIAA and HVA were assayed. Suicide intent with the Beck Suicide Intent Scale (SIS), lethality and violence of suicidal behaviour were assessed. All patients were followed up for causes of death. Six suicides and one fatal accident were identified with death certificates. Mean CSF 5-HIAA but not CSF HVA differed between suicides and survivors. Violent suicides had higher suicide intent and CSF 5-HIAA than non-violent suicides. In violent suicides, CSF 5-HIAA levels were negatively correlated with SIS. Greater suicide intent may be associated with greater aggressive intent and predicts a violent suicide method.

The Duration of the Suicidal Process

A history of suicide attempts is a major predictive factor for completed suicide with repeated self-harm constituting a particularly high risk. This study was undertaken to investigate suicide attempters' reports on the length of the period between consideration and accomplishment of a suicide attempt. Eighty-two patients referred to a psychiatric university hospital after a suicide attempt were approached within 3 days after the act. A semistructured interview focusing on the duration and related aspects of the suicidal process, the Barratt Impulsiveness Scale, the Beck Suicide Intent Scale, and the Montgomery-Asberg Depression Rating Scale were administered. Data were collected from July 2004 to December 2005. Nearly half of the patients (47.6%; N = 39) reported that the period between the first current thought of suicide and the actual attempt had lasted 10 minutes or less. Those patients in which this process had taken longer showed a higher suicidal intent (p < .001). Impulsivity was not associated with the duration of the suicidal process. Although the majority of the patients were alone during the suicidal process, 76.8% (N = 63) reported having had any kind of interpersonal contact. The process from the emergence of suicidal thoughts to the accomplishment of a suicide attempt, and thus the time for intervention, generally is short. However, in a considerable number of suicide attempters, there is at least some readiness for interpersonal contact with partner, family, or friends. Professional helpers appear to have limited potential for intervention during this phase. Thus, spreading information on signs of suicidality and interventional measures among the general population should be incorporated into suicide prevention strategies.

HPT axis, CSF monoamine metabolites, suicide intent and depression severity in male suicide attempters

A lower thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) in depressed women has been associated with violent suicide attempts, suicidal intent, higher lethality and suicide risk. The cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) levels are related to suicidal behaviour. We studied the HPT axis function in twelve male suicide attempters and eight healthy volunteers submitted to lumbar puncture and to TRH test. Suicidal behaviour and depression severity were assessed. There was no association between deltamaxTSH and violent suicidality or subsequent suicide. The deltamaxTSH correlated with CSF HVA in suicide attempters. The plasma T3 showed a negative correlation with the Beck Suicide Intent Scale and the Montgomery Asberg Depression rating scale. Dopaminergic regulatory mechanisms on the thyroid hormone activity may be altered in male suicide attempters.

Validating a short version of the Suicide Intent Scale in China.

As Beck's Suicide Intent Scale (SIS) gains popularity in various areas in the world, we are not sure whether the scale is an optimal measure of suicide intent in the Chinese culture. This study is to provide evidence to support the use of the Chinese shortened version of SIS (C-SIS) in Chinese societies. The data were from applying the C-SIS in a psychological autopsy (PA) study of 66 suicides in Dalian, China. Reliability and validity tests were performed on the C-SIS data. Internal consistency analysis showed excellent correlation coefficients for all items but one. Inter-rater reliability tests showed statistically significant correlations between each pair of informants for each item and for the total scores. Criterion validity analysis demonstrated a relatively high correlation between the scores on the Hamilton Depression Rating Scale (HAM-D) and C-SIS. Factor analysis produced three factors accounting for 66.77% of the total variance. The study suggested that C-SIS should be an appropriate instrument for detecting and measuring suicide intent in Chinese societies.

A Cluster Analysis of the Circumstances of Death in Suicides in Hong Kong

Classification of suicides is essential for clinicians to better identify self-harm patients with future suicidal risks. This study examined potential subtypes of suicide in a psychological autopsy sample (N = 148) in Hong Kong. Hierarchical cluster analysis extracted two subgroups of subjects in terms of expressed deliberation assessed by the Beck Suicide Intent Scale (SIS). The first group was associated with charcoal burning suicide, no psychiatric illness, indebtedness, better problem-solving ability, chronic stress, and higher overall SIS scores. The second group was associated with jumping from a height, psychotic disorders, psychiatric treatment, acute stress, and lower overall SIS score. The existence of a substantial cluster of subjects with lower expressed intent and preparation has important implications for the performance of the SIS as a predictive tool. Suicide prevention strategy may have to target potential subgroups with specific approaches.

Severity of depression and suicidal ideations among elderly people in Singapore

Studies in the West have concluded that the severity of depression is the strongest predictor of the course of suicidal ideations among the elderly. However, Asian culture tends to be more reserved and this may impact on the reporting of suicidal ideations. This study aims to determine the prevalence of suicidal ideation among depressed elderly people in Singapore and attempts to investigate the relationship between severity of depression and suicidality. Eighty consecutive depressed patients were recruited and severity of depressive symptoms rated with Beck's Depression Inventory (BDI). Suicidality was assessed using the Beck's Hopelessness Scale (BHS) and Beck's Suicide Intent Scale (BSS). Suicidal ideation was defined as any thought of wanting to kill oneself over the past seven days and not just a passive wish to die. 53.8% verbalized thoughts of wanting to kill themselves. Males were three times more likely to report suicidal thoughts. Severity of depression did not significantly influence the presence of suicidal thinking. The association of depression severity and suicidal ideations is not strongly supported. Elderly males were more likely to report suicidal ideations when depressed. Elderly patients who reported suicidal ideations were likely to be more severely depressed. However, in a depressed elderly person, the absence of suicidal ideations would not infer that the episode of depression was less severe.

The Relationship Between CSF HVA/5-HIAA Ratio and Suicide Intent in Suicide Attempters

There is a need to find stable biomarkers for suicidal behavior and suicide prediction. Reduced homovanillic acid/5-hydroxyindolacetic acid (HVA/5-HIAA) ratios in cerebrospinal fluid (CSF) in depressed suicide attempters have been reported. Suicide intent is a predictor of repetition of attempts and suicide. In the present study we investigated the relationship of HVA/5-HIAA ratio to the scales rating suicide intent and depressive symptoms. Fifteen consecutive medication-free male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital and eight healthy male volunteers underwent lumbar puncture and had the CSF monoamine metabolite levels assayed. Patients were assessed with the Beck Suicide Intent Scale (SIS), the Montgomery Asberg Depression rating Scale (MADRS) and the Chapman Scale of Anhedonia. Within the suicide attempter group, HVA/5-HIAA ratio was significantly associated with the Suicide Intent Scale (SIS), but not with the MADRS scale or the Chapman Scale of Anhedonia indicating that the HVA/5-HIAA ratio may be a biomarker of suicide intent.

Correlates of self‐harm behaviour in acutely ill patients with schizophrenia

This study compared acutely ill patients with schizophrenia with a history of self-harm (N=17) to those without a history of self-harm (N=16) on measures of depression, hopelessness, suicidal ideation, and demographic and psychiatric variables. A subgroup of these patients who experience auditory hallucinations, with and without a history of self-harm, were selected and compared on measures of depression, hopelessness, suicidal ideation and beliefs about voices. Employing a cross-sectional design, in-patients of two local psychiatric hospital, who met DSM-IV-TR criteria for schizophrenia and who were in an acute phase of the illness, were selected. Each patient was assessed using the Beck Depressions Inventory (BDI), Beck Hopelessness Scale (BHS) and the Beck Suicide Scale (BSS). Patients who experienced auditory verbal hallucinations completed the Beliefs About Voices Questionnaire Revised (BAVQ-R). Patients with a history of self-harm completed the Beck Suicide Intent Scale (BSI). Patients with a history of self-harm (N=17) had significantly greater symptoms of depression, greater suicidal thoughts, increased number of hospital admissions, greater duration of illness and were more likely to be married, compared to patients without a history of self-harm (N=16). Among the subgroup of patients who experience auditory hallucinations, those with a history of self-harm (N=9), believed their voice to be more malevolent, had a tendency to resist their voice and experienced significantly greater symptoms of depression and hopelessness compared to those without a history of self-harm (N=6). These findings highlight the importance for screening by clinicians during inpatient hospital stays and for monitoring to be ongoing following discharge. For the subgroup of patients who experience auditory hallucinations, future research should seek to explore the relationship between self-harm and beliefs about voices.

Planning of suicide attempts among depressed inpatients ages 50 and over

Background Suicidal behavior is heterogeneous; suicide attempts can be impulsive (lower planned) or reflect forethought and preparation (higher planned). Lower planned and higher planned attempts may have different correlates that require different prevention strategies. Based on a model of suicide planning relevant to middle-aged and older adults, we tested the following hypotheses: physical illness burden, decreased functional capacity, hopelessness, and living alone are associated with suicide attempts that are more extensively planned; lower cognitive functioning is associated with suicide attempts that are more impulsive. Methods Subjects were 117 inpatients ages 50 and over diagnosed with major depression based on semi-structured clinical research interviews, the medical record, plus other records when available. All subjects had attempted suicide within 1 month of admission. The degree of planning prior to the suicide attempt was quantified using Beck's Suicide Intent Scale. Multivariate linear regression analysis identified correlates of planning. Results As hypothesized, lower cognitive functioning was associated with lower levels of planning. Contrary to the hypothesis, impaired physical self-care was associated with lower (not higher) planning. Results pertaining to living alone were equivocal. Limitations The study was limited by the cross-sectional research design and unclear generalizability to completed suicide or to racial/ethnic minorities. Conclusions Depressed patients with lower cognitive functioning and impairments in physical self-care may be especially vulnerable to impulsive suicidal behavior. The potential role of living alone in higher planned suicidal acts requires further investigation.

CSF 5‐HIAA, suicide intent and hopelessness in the prediction of early suicide in male high‐risk suicide attempters

To study the predictive value of the Beck Suicide Intent Scale (SIS), the Beck Hopelessness Scale (BHS) and of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid for future early suicide in a group of high-risk male suicide attempters. Fifteen consecutive male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital, who were not receiving any treatment with antidepressants were diagnosed according to DSM-III, assessed with SIS and BHS and submitted to lumbar puncture. All patients were followed up for cause of death. Five early suicides (within 2 years) were identified. Mean cerebrospinal fluid (CSF) 5-HIAA differed between suicides and survivors. Low CSF 5-HIAA was identified in those who committed early suicide. Neither the Suicide Intent Score nor the Hopelessness Score distinguished suicides from survivors. In high suicide risk hospitalized male psychiatric patients CSF 5-HIAA may be a better predictor of early suicide after attempted suicide than SIS or BHS.

Suicidal intent in deliberate self-harm and the risk of suicide: The predictive power of the Suicide Intent Scale

Background Suicidal intent at the time of deliberate self-harm (DSH) is known to be associated with risk of future suicide in DSH patients. The predictive power of suicidal intent to identify particular individuals who are at high risk of suicide is unclear. Method Clinical and demographic data on 4156 DSH patients presenting to hospital 1993 and 1997 were analysed. Follow-up information on eventual suicide was available for 2489 patients (mean follow-up 5.2 years). The predictive value of the Beck Suicidal Intent Scale (SIS) was examined using Receiver Operating Characteristic (ROC) plots. Results Thirty males (2.9%) and 24 females (1.7%) died by suicide. Despite a robust association between suicidal intent and eventual suicide, the positive predictive value (PPV) of the SIS was low (4%). Predicted probabilities of suicide assigned to individual patients were also low, even for those who eventually died by suicide. Limitations Assessment and follow-up information was not available for all patients. Conclusions The SIS cannot predict which individual patients will ultimately die by suicide. Nonetheless, information regarding suicidal intent is valuable in the clinical risk assessment and management of DSH patients.

Severe suicide attempts in young adults: suicide intent is correlated with medical lethality

Suicidal behavior is currently thought of as a continuum. Although there is a wide variety of such behavior, most of the information for the construction of epidemiological standards is still derived from statistics of death by suicide. However, the burden associated with suicide attempts represented 1.4% of the overall burden of diseases in 2002. It is estimated that this figure will reach 2.4% in 2020. Our study evaluated 121 patients who had been hospitalized because of medically severe suicide attempts, at Hospital das Clinicas of the Universidade Estadual de Campinas. Beck's Suicide Intent Scale (IS) was used for measuring the patient's intention of dying. The degree of lethality was evaluated on a six-point scale, based on the patient's clinical status and also on the procedures performed during hospitalization, clinical parameters, threat to life and the attending physician's impressions. The Spearman correlation test was used, for all patients and according to age groups, to evaluate the correlation between suicidal intent and lethality. There was a correlation between suicidal intent and lethality (correlation coefficient of 0.42; p = 0.04) within the 30 to 39-year-old group (38 individuals). Most of these patients were male (60%) and were married or living with someone (60%). 44% had a history of psychiatric treatment. Poisoning was the method most commonly used (88%) and 52% of the patients had the diagnostic hypothesis of affective disorder. Previous studies have shown a correlation between lethality and intent, based on the assumption that the individuals are aware of the lethal potential of their suicide attempt. In our study, we strictly evaluated severe suicide attempts, carefully measuring suicidal intent and lethality. We noted that, for at least one third of the patients, there was a correlation, albeit moderate, between the desire to die and the lethality of the method chosen for suicide. Therefore, the resulting injuries were severe and life-threatening. Some of the patients would probably have died, had they not been cared for in a hospital. In the future, would these patients be at higher risk of dying through suicide? If we take the scientific literature into account, the answer is yes.

Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury

Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour. To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide. Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997. Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients. The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.

Suicide attempts and impulsivity

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one-year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Beck's Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.

Variables associated with hospitalization decisions by emergency psychiatrists after a patient's suicide attempt.

This study explored the factors psychiatrists considered in deciding on hospitalization for a large sample of suicide attempters in the emergency department of a general hospital in Madrid, Spain, between 1996 and 1998. Psychiatrists assessed 509 patients who had attempted suicide; 196 of these (39 percent) were hospitalized in the psychiatric unit, and 313 (61 percent) were discharged from the emergency department. The assessment included Beck's Suicidal Intent Scale (SIS) and a checklist of 47 clinical variables. Of the 32 clinical variables significantly associated with hospitalization that were introduced in a logistic regression model, 11 remained significant. Six variables were associated with an increased odds of hospitalization: intention to repeat the attempt, plan to use a lethal method, low psychosocial functioning before the suicide attempt, previous psychiatric hospitalization, a suicide attempt in the past year, and planning that nobody would try to save their life after they had attempted suicide. Five variables decreased the odds: a realistic perspective on the future after the attempt, relief that the attempt was not effective, availability of a method to kill oneself (that was not used), belief that the attempt would influence others, and family support. Models based on the SIS total score and individual SIS items had lower specificity and sensitivity. Psychiatrists appear to rely on patients' self-report in deciding on hospitalization rather than focus on demographic, diagnostic, or psychosocial issues. If the findings of this study were replicated in other hospital settings, the implication would be that the guidelines for assessing suicide attempts need to encourage thorough and detailed assessment of the attempt and the future plans.