matched to the National Death Index, and death certificates were obtained for those who had died. Through this process, 49 suicide cases were identified. The average length of follow-up was 10 years, and the average length of time to death was approximately 4.3 years from the baseline interview. Patients who scored above 3 on the SSI were about 6.5 times more likely to complete suicide than patients who scored below this cut-off.

Other scales that have been shown to have some predictive validity include the Beck Hopelessness Scale, Beck Depression Inventory, Beck Anxiety Scale, and the Hamilton Rating Scale for Depression. Measurements of personal contentment, such as Linehan’s (1983) Reasons for Living Inventory and Koivumaa-Honkanen and colleagues’ (2001) simple life satisfaction measure, also seem to have value in some populations. All of the instruments have their strengths as well as their weaknesses, but there may be no single “best” instrument for all purposes. The choice of instruments depends on the needs of the clinician or researcher, the intended use of the instruments, and an assessment of how an instrument compares to other similar instruments in meeting diagnostic needs. Furthermore, the age, gender, and culture of the suicidal individual must also be considered in choosing assessment scales. Some measures of psychopathology and suicide risk may not be as accurate or appropriate for specific populations, since risk and protective profiles differ across ethnicity, gender, and age. Cognitive measures of mental disorders, for example, may not be as sensitive for ethnic groups that experience psychopathology in more somatic than in cognitive terms (Marsella et al., 1975; Marsella and Yamada, 2000), and culture and developmental stage (e.g., single adolescent vs. adult parent) influence such things as reasons for living (see Chan, 1995; Linehan et al., 1983; Osman et al., 1998).

Confounding Factors

Variations in Purpose

Assessment tools differ; there are detection instruments, risk assessment instruments, and instruments for assessing clinical characteristics of suicidal behavior. Each of these groups of instruments is useful for answering certain types of questions, but the use of the wrong instrument may yield insufficient or even misleading information. A risk assessment instrument will not provide information about whether someone is currently suicidal (an issue of detection). A person may score “low” on a risk assessment instrument assessing a particular domain (e.g., hopelessness) while still experiencing suicidal ideation or even having made a recent attempt (Goldston, 2000).



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