Beck Suicide Intent Research Articles

Childhood maltreatment increases the suicidal risk in Chinese schizophrenia patients.

ObjectivesChildhood trauma might be a modifiable risk factor among adults with serious mental illness. However, the correlation of child trauma and suicide is unclear, which were cited most frequently as the biggest challenge to schizophrenia (SCZ) patients in China. We aim to study relationships between child trauma and suicide in SCZ patients of different disease stages.MethodsNinety-one participants were included and divided into two groups, namely, first-episode group (n = 46), relapsed group (n = 45). The Positive and Negative Syndrome Scale was used to evaluate the severity of psychotic symptoms. The Beck's Suicide Intent Scale and The Nurses' Global Assessment of Suicide Risk were conducted by patient self-report to assess suicide symptom. The childhood trauma questionnaire was used to estimate severity of traumatic stress experienced during childhood.ResultsChildhood trauma and different dimensions of suicide were significantly higher in the relapsed group than first-episode group (P < 0.01, respectively). BMI has a significant positive relationship with recent psychosocial stress (β = 0.473, t = 3.521, P < 0.001) in first-episode group. As in relapsed group, BMI has a positive effect between severe mental illness and suicide ideation (β = 0.672, t = 5.949, P < 0.001; β = 0.909, t = 2.463, P < 0.001), Furthermore, emotional neglect presented positively related to the suicide risk and proneness to suicidal behavior (β = 0.618, t = 5.518, P < 0.001; β = 0.809, t = 5.356, P < 0.001).ConclusionRelapsed group of patients had significantly more severe childhood trauma, recent psychosocial stress, suicidal risk and proneness to suicidal behavior. BMI and emotional neglect are unique predictors for different dimensions of suicide.

Sociodemographic profile and intention of deliberate self-harm among patients admitted in a tertiary care hospital, Chittagong, Bangladesh

Introduction: Deliberate self-harm (DSH) is an act with nonfatal outcome, in which an individual deliberately initiates a nonhabitual behavior that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of prescribed or generally recognized therapeutic dosage. Here, the objective of the present study was to demonstrate the sociodemographic profile and intention of DSH in our context. Methods: This prospective observational study was done during 1 year. A total of 51 cases were recruited. Sociodemographic data were collected and intension to DSH was assessed using Beck's Suicide Intent Scale. All patients were followed up until discharge, and data were analyzed using the SPSS-20. Results: Among all 51 cases female were the most common 48 (94.1%), Muslims were more 41 (80.4%), 31 (60.8%) were from urban origin, most were homemaker, 20 (39.2%) were single, 16 (31.4%) were poor, and most were at age group

Suicidal intent in people with major depression

BackgroundDepression is most common underlying contributor among cases of attempted/completed suicide. There is dearth of information regarding suicidal intent among people with depression and its relationship with hopelessness among Indians.ObjectiveTo evaluate and describe the intent of suicide in people with depression among north Indian population.MethodsThis cross-sectional single point, study was performed at the department of psychiatry, King George's Medical University, Lucknow, India. Cases were in the age group of 18–60 years with major depressive disorder as per DSM-IV TR criteria. Following tools e.g. Hamilton depression rating scale (HRS), Beck's hopelessness scale (BHS) and suicide intent questionnaire (SIQ) were used for assessment.ResultsSuicidal intent was observed among 68.1% (n = 49) of study sample (n = 72). There was no significant (P &gt; 0.05) association of suicidal intent with socio-demographic factors except domicile status. Suicidal intent was common among people with moderate to severe depression and those with hopelessness. The hopelessness was present among 70.8% of subjects.ConclusionSuicidal intent is prevalent among people with major depression. Intervention at initial stage of suicidal intention would of importance for successful preventive measure. This emphasizes the need for evaluation of suicidal intent in cases of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Suicide and self-harm related internet use in patients presenting to hospital with self-harm: a cross-sectional study

BackgroundEvidence that the internet might be being used in planning suicidal acts, promoting suicidal behaviour, and accessing help, adds a new dimension to suicide prevention. Yet research into the frequency and type of internet use before suicide is lacking. We investigated self-harm related to internet use among patients who presented to hospital with self-harm. MethodsData on self-harm presentations to the emergency departments of an adult hospital (Jan 1, 2013, to Dec 31, 2015) and a children's hospital (Sept 1, 2013, to Nov 30, 2015) in a large city in the South West of England were obtained from a local self-harm surveillance register. Patients who had psychosocial assessments (65% of adult and 82% of children's hospital presentations) were asked during the assessment about internet use associated with their presentation. Beck Suicide Intent (BSI) scale was used to assess suicidal intent. Multivariable logistic regression models were performed to investigate the association between internet use and sociodemographic characteristics, clinical characteristics, and repeat presentation within 6 months. The self-harm register has ethics approval. Findings1192 first presentations to the adult hospital (mean age 35 years, SD 14·7) and 312 to the children's hospital (14, 1·1) had data recorded about internet use, age, and sex. Prevalence of self-harm related to internet use was 8·4% (n=100) among adult presentations (8·9% men, 8·0% women) and 26·0% (n=81) among children's presentations (26·3% boys, 25·9% girls). In both samples, self-harm related to internet use was associated with high intent (BSI >8) (odds ratio for adults 2·6, 95% CI 1·6–4·4; children 2·0, 0·9–4·3) but not repeat presentation (0·9, 0·5–1·8; 0·6, 0·2–1·3). InterpretationThe findings indicate that self-harm related to internet use is likely to become increasingly relevant as the internet-native generation matures and might be a proxy marker for intent. The inclusion of questions about internet use in clinical self-harm assessments could provide an alternative means by which to explore complex issues. More generally, assessments may require updating in light of technological advancements. However, further research, which differentiates between types of internet use and explores the impact of asking about internet use, is necessary. FundingNone.

Sleep disturbance as a proximal predictor of suicidal intent in recently hospitalized attempters

ObjectivesInsomnia and short self-reported sleep duration are associated with suicidality, adjusting for concurrent depression. Yet, it is unknown whether they correlate with attempters' suicidal intent and the lethality of suicidal acts. This cross-sectional study in hospitalized suicide attempters aimed to investigate whether temporally proximal self-reported sleep disturbance predicts suicidal intent or exerts mediatory effects. MethodsAttempters were retrospectively assessed for insomnia severity (Athens Insomnia Scale [AIS]) and average night sleep duration (ANSD) for 2 weeks preceding attempt. The effects of insomnia or ANSD on suicidal intent (Beck's Suicide Intent Scale [BSIS]) were explored in multiple regressions. Mediatory effects were investigated in structural equation models (SEMs). ResultsA total of 127 adults (59.8% females) were interviewed within two weeks post–suicide attempt. Major psychiatric diagnoses included affective, psychotic, and alcohol-related disorders. Of the participants, 38.6% had current major depression (MDE). A total of 62.2% reported insomnia (AIS ≥ 6); 42.5% reported short ANSD (≤5 hours). BSIS was predicted by AIS (p = 0.034), short ANSD (p = 0.015), or insomnia with short ANSD (p = 0.006). In SEMs, indirect effects of current MDE, affective disorder, and alcohol-related disorder diagnoses on BSIS via AIS tested significant; both AIS and short ANSD partially mediated the effect of age on BSIS. ConclusionInsomnia, short ANSD, and, in particular, insomnia with short ANSD proximally predicted suicidal intent in recent attempters. The effects of current depression and affective and alcohol-related disorder diagnoses on suicidal intent were partially mediated by insomnia; both insomnia and short ANSD partially mediated the effect of age on suicidal intent. Therefore, management of sleep disturbance in at-risk subjects is important, as it may reduce unfavorable outcomes of suicidal acts.

Scientific Letter: High-intent suicide and the Beck’s Suicide Intent scale: a case report

Suicide is the act of intentionally causing one's own death. Some acts of suicide are recognized as impulsive (low-planned) behavior; while others are characterized by having signs of serious and planning (intermediate or high-planned) acts. Women and younger individuals are more likely to carry out and intermediate-planned than high-planned acts of suicide. The Beck's Suicide Intent Scale (SIS) is a semi-structured, interviewer administered assessment scale consisting of 15 items. The scale consists of 2 sections, the first of which is objective, and in the second section, subjective characteristics of the suicide attempt are evaluated. SIS scores obtained are classified as: 10 points low- intent, 10-15 points intermediate- intent, and >15 points high- intent suicides.

Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons

Suicides in prisons are common. There is a pressing need to understand more about the causes and prevention of prisoner suicides. A particularly informative approach is through studying survivors of near-lethal suicide attempts. However, the extent to which this approach is a good proxy for completed suicide requires verification. In this article we aimed to assess (1) the extent to which male and female prisoners who made near-lethal suicide attempts in prison are similar to prisoners who die by suicide; (2) the suicidal intent of those making near-lethal suicide attempts; and (3) the applicability of the Suicide Intent Scale in prisons. Survivors of near-lethal suicide attempts and prisoners who died by suicide were compared on sociodemographic and criminological characteristics. The suicidal intent of prisoners engaging in near-lethal self-harm was assessed using Beck's Suicide Intent Scale. There were no significant differences when the sociodemographic and criminological profiles of prisoners who made near-lethal suicide attempts and those who died by suicide were compared, except that male prisoners who made near-lethal suicide attempts were somewhat younger. Most prisoners carrying out near-lethal acts had high suicidal intent. However, some questions in the Suicide Intent Scale were inappropriate for assessing intent in prisoners. Prisoners who survive near-lethal self-harm would appear to be a valid proxy for those who die by suicide in prison. The Suicide Intent Scale requires some modifications for use in prisons.

Brief Suicide Questionnaire. Inter-rater reliability

IntroductionInter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behaviour (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. MethodIn the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behaviour. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). ResultsInter-rater agreement was between poor (<70%) to excellent (90–100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5% to 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in Beck's Suicidal Intent Scale, ranged from 67.5% to 97%; in Beck's Scale for Suicide Ideation, ranged from 63.5% to 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. ConclusionThe proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

Short self-reported sleep duration and suicidal behavior: A cross-sectional study

Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. Cross-sectional. Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. Sleep duration was assessed only by self-report. The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.

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.

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.

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.

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.

Do we manage deliberate self-harm appropriately? Characteristics of general hospital patients who are offered psychiatric aftercare

BACKGROUND The appropriateness of psychiatric management decisions following an episode of deliberate self-harm is under-researched. AIM To determine whether the offer of follow-up or psychiatric admission by psychiatric doctors is related to known predictors of repetition of self-harm or completed suicide, and recognition of a depressive disorder. METHODS Prospective survey of 158 adult self-harm referrals from the general hospital. RESULTS Offer of aftercare was significantly associated with a definite wish to die at the time of the attempt (P<0.001), Beck's Suicide Intent score (P=0.001), Beck's Hopelessness score (P=0.001), age (P<0.01) and an ICD-10 diagnosis of depression (P<0.001). Psychiatric admission was more likely for men (P=0.01) and accommodation problems (P=0.04) and less likely for relationship problems (P=0.01). CONCLUSIONS Psychiatrists are selectively admitting or following up patients from established high-risk groups. Given the limitations of suicide prevention and mental health resources, their management is appropriate.

A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts.

Biological studies suggest that lower serotonergic activity is associated with both greater suicide lethality and impulsive personality traits. These results may lead to the conclusion that impulsivity in the attempt should be associated with greater lethality. However, Klerman's review of epidemiologic suicide studies suggests an inverse relationship between impulsivity and lethality. This seemingly paradoxical relationship between impulsivity and lethality has not been explored in large representative clinical samples of suicide attempts. During 1996 to 1998, 478 individuals who attempted suicide were studied in a general hospital in Madrid, Spain. Impulsivity was measured as described in the literature by combining 2 items of Beck's Suicidal Intent Scale (active preparation for attempt and degree of premeditation). Lethality of the attempt was assigned 1 of 4 levels according to the need for medical and/or psychiatric treatment. More than half of the attempts were impulsive (55%; 95% confidence interval [CI], 51% to 59%), approximately one fourth of the attempts had an intermediate level of impulsivity (28%; 95% CI, 24% to 32%), and approximately one sixth of the attempts were not impulsive (17%, 95% CI, 13% to 21%). There was an inverse association between the impulsivity and lethality of the suicide attempt (chi2 = 62.639, df = 6, p < .0001). The most impulsive attempts tended to result in less morbidity, while the less impulsive attempts tended to be more lethal. If the inverse relationship between impulsivity and lethality is replicated in other large and representative samples, new studies will be needed to clarify the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicidal behavior.

Adolescent suicidal behaviours: a population-based study of risk

Reports of adolescent suicidal behaviour have generally derived from clinical settings but population-based studies are likely to provide a clearer epidemiological view. Non-fatal suicidal behaviours were studied in 1699 Australian 15- to 16-year-old secondary school students at 44 schools in the state of Victoria, Australia. Self-reported episodes of self-harm were characterized using items from the Beck Suicide Intent Scale. The 12 month weighted prevalence estimate for deliberate self-harm was 5.1%. The commonest forms were self-laceration (1.7%), self-poisoning (1.5%) and deliberate recklessness (1.8%). Self-poisoning and self-laceration were commoner in girls. The prevalence of 'true suicide attempts' was 0.2%. Most self-harmers did not perceive death as likely, plan self-harming episodes at length or inform others of the episodes. Psychiatric morbidity had the strongest association with self-harm, an association which held for all subtypes. Antisocial behaviour and substance abuse were associated with self-harm in girls but not boys. Sexual activity was independently associated with self-harm in both genders. Deliberate self-harm was common but the great majority of episodes were not 'true suicide attempts'. It is, therefore, possible that attributable mortality and morbidity may be greater in self-harmers without definite suicidal intent.

Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression

This study examined the risk prediction efficiency of the Reasons for Living Inventory Survival and Coping Beliefs Scale, Beck Hopelessness Scale, Beck Depression Inventory, and the Life Experiences Survey with a sample of 51 newly hospitalized parasuicides. The index of suicidal potential chosen for this study was suicide intent as measured by Beck's Suicide Intent Scale. Regression analyses indicated that the Survival and Coping Beliefs Scale emerged as the single most important predictor of suicide intent. Hopelessness and depression made secondary and nonsignificant contributions. Hopelessness was a significant predictor of suicide intent when analyzed apart from Survival and Coping Beliefs, but not among a subsample of 43 repeat parasuicides. Classification analyses showed that neither hopelessness nor survival and coping beliefs were accurate at classifying low- or high-intent parasuicides. Factors contributing to the efficacy of survival and coping beliefs as a risk prediction index are discussed, as is the false-negative dilemma in suicide risk assessment and prediction.

Suicidal intent, hopelessness and depression in a parasuicide population: The influence of social desirability and elapsed time

This paper reports the first British study to assess the construct validity of Beck's Hopelessness Scale (HS) and the Beck Depression Inventory (BDI). On the basis of interviews with 50 economically active parasuicide patients, it was confirmed that hopelessness accounts for the relationship between depression and suicidal intent. Moreover, it was shown that social desirability neither confounds the relationship between hopelessness and suicidal intent, nor has any predictive power in explaining variation in suicidal intent. On the other hand, the interval ('elapsed time') between the commencement of the parasuicidal act and of the research interview was significantly and positively correlated with suicidal intent, and elapsed time was a significant predictor of the total score on Beck's Suicidal Intent Scale. Two explanations for this finding are proposed: the first is based on the possibility that elapsed time is an indirect or proxy measure of medical seriousness; the second derives from the likely impact of prolonged hospital stay on the patient's interpretation or understanding of his/her behaviour. Researchers are advised to take into account the moderating effect of elapsed time when designing studies which examine psychological processes in parasuicide.