Morrison and Downey, 2000; Negron et al., 1997). No psychological test, clinical technique, or biological marker is sufficiently sensitive and specific to accurately assess short-term prediction of suicide in an individual (Goldstein et al., 1991). A prospective study (Pokorny, 1983) of 4800 consecutive patients at a Veterans Administration hospital used 21 known suicide risk factors to identify 803 patients with increased risk of suicide. Thirty of these identified patients completed suicide during a 5-year follow-up period. But an additional 37 patients than had not been assessed as at-risk also completed suicide. Even an optimal measure with the unrealistically low rate of false-positives and false-negatives (1 percent) would only correctly assess 20 percent of those who complete suicide (MacKinnon and Farberow, 1976). Assessment instruments can be useful tools but are not a substitute for clinical judgement. Nevertheless, assessment is an important component of psychopharmacological and psychotherapeutic interventions.
Whether using a standardized psychological test or interview only, it is important to assess for suicidal symptoms, symptoms of the known risk factors for suicide, and current abilities to cope with acute or chronic stress (Bech et al., 2001). Assessment instruments fall into four broad categories: (1) detection instruments, (2) risk assessment instruments, (3) assessment of clinical characteristics of suicidal behavior, and (4) a miscellaneous category (e.g., compilations, assessment of attitudes around suicide, projective psychological tests1). Assessment tools for adults and youths have been extensively reviewed by Brown (2000) and Goldston (2000), respectively.
One of the most widely used and best-evaluated measures is the Scale for Suicide Ideation (SSI) (Beck et al., 1979). It is a 19-item scale, available as interview, self-report, or computer-administered. Only if a person endorses an item indicating intent to complete suicide, is the rest of the scale administered. It has been standardized on both inpatient and outpatient clinical samples. It has also been used in emergency rooms, primary care settings, jails, and in college student samples. A prospective study with almost 7000 patients and an approximately 20-year follow-up with psychiatric outpatients used standardized, structured interviews and standardized assessment measures (Brown et al., 2000). These data were