Suicide assessment

A Review of Suicide Assessment Measures for Intervention Research with Adults and Older Adults

Gregory K. Brown, Ph.D. University of Pennsylvania

Correspondence: Gregory K. Brown, Ph.D., Room 2030, 3535 Market Street, Philadelphia, Pennsylvania, 19104-3309. Email: Browng@landru.cpr.upenn.edu Acknowledgements: The author would like to thank Randy Fingerhut, Ph.D., Gregg R. Henriques, Ph.D.,Hilary Himes, and Anna Tverskoy who assisted with the preparation of this manuscript. Editorial comments from Aaron T. Beck, M.D., Yeates Conwell, M.D., David Goldston, Ph.D., David A. Jobes, Ph.D., Marsha M. Linehan, Ph.D., Jane L. Pearson, Ph.D., Holly Prigerson, Ph.D., M. David Rudd, Ph.D., and Robert A. Steer, Ed.D. are greatly appreciated. The author is also grateful to the authors of theassessment measures in this review who provided assistance.

Suicide Assessment Preparation of this manuscript was supported by contract 263-MH914950 (Dr. Brown) and grants R37MH47383 and R01MH60915 (Dr. Beck) from the National Institute of Mental Health.

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Suicide Assessment A Review of Suicide Assessment Measures for Intervention Research with Adults and Older Adults According theNational Center for Health Statistics, there were 29,199 U.S. suicide deaths, or a rate of 10.7 per 100,000 in 1999. It was the 8th leading cause of death for males, who outnumber female suicide deaths by 4 to1. Half as many African American and Hispanic Americans died by suicide compared to whites. Suicide is the third leading cause of death for adolescents and young adults (ages 15-24 years) and thefourth leading cause for young adults (ages 25-44 years). These mortality statistics also indicate that older white males aged 85 or older have the highest rates of suicide, exceeding the national average by 6-fold (Hoyert, Airas, Smith, Murphy, & Kochanek 2001). Recognizing that suicide has profound public health significance, the United States Senate (Resolution 83: Recognizing Suicide as aNational Problems and Declaring Suicide Prevention to be a National Priority, Congressional Record, 1997) and the Surgeon General (The Surgeon General’s Call to Action to Prevent Suicide, U.S. Public Health Service, 1999) have declared suicide prevention to be a national public health priority. The Surgeon General has recommended the implementation of a National Strategy for Suicide Prevention. Amongthe many recommendations made, the Surgeon General encouraged the development of scientific strategies for evaluating suicide prevention interventions. Specifically, the evaluation of neurobiological and psychosocial interventions for individuals at risk for suicide (e.g., patients with mental disorders) was strongly endorsed and seen as necessary for achieving the goal of suicide prevention (U.S.Department of Health and Human Services, 2001). Unfortunately, information on whether biological or psychosocial treatment actually reduces suicidality is limited. One reason for this limited information is that most randomized clinical trials have attempted to examine the efficacy of a targeted intervention while excluding those individuals who are clinically determined to be at high risk forsuicide (Pearson, Stanley, King & Fisher, 2001). The exclusion of individuals from studies may be attributed to the belief that the randomization of suicidal individuals to a treatment condition is unethical or too risky (Linehan, 1997). A second reason for this limited information may be that reliable and valid measures of suicidal behavior are not commonly used in clinical trials. As the NationalInstitute of Mental Health (NIMH) continues to encourage intervention research to include heterogeneous samples that are more representative of the general mental health population, clinical researchers are more likely to encounter patients with suicidal ideation or behavior. Therefore, established assessment instruments that measure changes in suicidality are required to determine whether...