Suicide lethality assessment tool

Reported clinical correlates of lethality vary widely and include intent to die, hopelessness,[ 5 , 6 , 7 ] males with bipolar disorder,[ 8 ] problems with sharing of feelings with others,[ 9 , 10 ] use of alcohol,[ 11 ] etc. In a study of suicide attempters patients who wished to change compared to those who wished to die were reported to have low lethality attempts. The concept of lethality is essential to the assessment of suicide risk; yet operational definitions of lethality for purposes of its measurement have been loose and varied.

Lethality is the possibility or degree to which any biological change that could have endangered the life of the suicide attempter. However, the final outcome, death or survival, depends upon various factors that can influence the degree of the lethality of an attempt.

Lethality assessment mainly focuses actual lethality of the method used and the circumstances surrounding the attempt. Circumstances of the attempt influence the degree of lethality; it determines the chance of rescue rescuability from the situation. Lethality can also be indicated by severity of physical consequences symptoms, signs, disability etc.

Assessment of lethality should ideally take into account all these factors. A number of scaling measures have been published in the literature, with no relative consensus.

The scale gives reference and examples on physical injury and lethal doses of the ingested substance which makes the scale more appropriate for clinicians; although the authors suggested that the scale can be used reliably by nonmedical personnel with no prior training. The methods and substances used for attempts vary so widely in different places and periods that these factors may restrict its use in areas where these information or accurate account of an attempt is not available.

We intended to develop and test utility of a new scale for measuring lethality that can describe the seriousness of the attempt and reflect overall clinical observation taking into account various indicators. It was envisaged that the new scale would be useful across cultures and setups, which can be used in different clinical scenarios involving various methods.

Consecutive patients who were brought to the hospital with alleged history of suicide and attempted suicide, within a period of 1 year, were taken up for the study. Information was collected from accompanying family members, friends, and hospital case records; along with through interview of the surviving patients.

Informed consent from the patient or family members in case of deceased was taken. Besides demographic data, information that would indicate the severity of attempt, e.

Through the narrative history, or by psychological postmortem method for those who succumbed we also collected factors associated with suicide attempt, e.

It was ascertained whether the attempter had chosen a place or time to avoid discovery. We also found out whether the suicide attempter had psychiatric illness, treatment, and admission. The factors that describe the dangerousness or seriousness of suicide attempt and indicate lethality were discussed amongst the multidisciplinary professionals and the clinical impressions suggesting different degrees of lethality were ascertained.

From various items considered for the scale initially, the final version was agreed through a consensus method following discussion among faculties from Departments of Forensic Medicine and Toxicology, Psychiatry, and Medicine.

LSARS is an point scale starting from 0. Risk and rescue factors associated with the suicide attempt were studied by risk-rescue rating scale. Rescue factors studied were: Locations, person initiating rescue, and probability of discovery, accessibility for rescue and delay until discovery.

They were rated on a three point scale and referred in five grades of risk or rescue. Statistical measures used included Cronbach's alpha, correlation, Chi-square tests, Student's t -test, analysis of variance ANOVA , and binary logistic regression analysis.

The level of significance was kept at the standard 0. Sociodemographic characteristics of the sample are given in Table 1 , which were not significantly different between those who succumbed to their attempt compared to those who survived. Most of the sample survived Those who died were significantly older It was observed that around 9 History of past suicide attempt was there in 9 Only a small proportion 3.

Duration of contact with psychiatric services for most of them 10 out of 14 was years. The differences in these parameters between the deceased and survived were not significant. Factors associated with suicide attempt are given in Table 2.

These factors describe the cognitions and communications before attempt, method and the level of medical interventions reflecting the seriousness of the attempt. Comparing various categories of lethality on GIL between succumbed and survived attempters, the proportions in percentages were: Subliminal 0. Risk scores of deceased Individuals who survived the attempt had higher rescue scores Content validity for the scale was established by the multidisciplinary panel of experts from medicine, forensic medicine and toxicology and psychiatry through several rounds of discussion on revised items.

Agreement was reached on the item composition by the consensus method. Internal consistency is the degree in which the items on the measure consistently assess the same construct. We compared known groups which are expected to have differences in the lethality to determine whether SALSA could distinguish between these groups, as a measure of assessing the discriminant validity. This was analyzed by performing t -test and ANOVA comparing SALSA scores between groups defined by clinical and suicidal act related variables with a probability of differences in lethality.

Between the survived and succumbed groups it was expected that the deceased group would have significantly higher scores compared to the survived group. Attempts of individuals with intent to die was associated with higher lethality Attempters who had taken precautions to avoid discovery had higher SALSA score compared to those who did not Interestingly impulsive attempts were more lethal Considering the level of intervention received by the attempters there was a distinct difference in the SALSA scores in different categories; in-patient only: Although the SALSA scores of males compared to females, attempters who used physical compared to chemical methods, and those with the death wish, suicidal ideas and threats compared to those who did not have these were more, these differences did not reach statistical significance.

Predictability of lethal outcome was assessed for SALSA score using binary logistic regression analysis. The study tried to validate a new scale to measure the lethality of suicide attempts taking into account global impressions about various aspects that indicate the severity of the attempt. While lethality assessment and risk assessment are overlapping concepts, they do not measure the same thing.

After the general resources provided below, you will find materials related to six leading assessment tools. Lauren Bennett Cattaneo suggests that instead of asking, "What are the chances violence will occur? Integrating Risk Assessment in a Coordinated Community Response from the Battered Women's Justice Project explores the benefits of utilizing risk assessments and reviews the various available tools.

It offers considerations and resources to support CCR teams engaging in this process. This document critiques several lethality assessment tools and examines the link between these instruments and research on domestic homicide. Discusses the antecedents of lethal violence and utility of dangeousness assessment tools in promoting safety. This paper describes several risk assessment instruments available to the corrections community, and addresses frequently asked questions regarding implementation and other considerations.

This report provides descriptions and analyses of assessment tools, investigative checklists, and protocols used by criminal justice personnel in Canada to measure risk in domestic violence cases. This meta-analysis reviews the predictive accuracy of different approaches and tools that are used to assess the risk of recidivism for male spousal assault offenders. The central purpose of this study was to assess the accuracy of several different approaches to predicting risk of future harm or lethality in domestic violence cases.

Discussion We examined the evidence for the diagnostic accuracy of suicide risk assessment tools in a systematic review. Strengths and limitations The current review expands on findings of previous clinical reviews of suicide assessment instruments thanks to the stringent database search and the uniform, structured assessment of risk of bias and certainty of the evidence. Research implications A large number of studies had to be excluded from the present systematic review due to high level of bias, highlighting the need for enhanced rigor in study design.

Clinical implications Most of the studies included in this review were carried out in research settings, and it remains unclear whether suicide risk instruments might improve prediction when used as a complement to the global clinical assessment. Supporting information S1 File Report in Swedish. PDF Click here for additional data file.

S2 File Explanation of the submission and its relation to the Swedish report. DOCX Click here for additional data file. S3 File Permission from the Swedish agency for health technology assessment. DOC Click here for additional data file.

S1 Table Search strategy. S2 Table Excluded articles. S3 Table Characteristics of the included studies. Data Availability Three supporting information tables are submitted for the data. References 1. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. Contact with mental health and primary care providers before suicide: a review of the evidence.

Am J Psychiatry. Suicide and hospitalization for mental disorders in Sweden: a population-based case-control study. Journal of psychiatric research. Hospital management of suicidal behaviour and subsequent mortality: a prospective cohort study.

Lancet Psychiatry. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice.

Acad Psychiatry. Bolton JM. Suicide risk assessment in the emergency department: out of the darkness. Depress Anxiety. Suicide risk assessment and intervention in people with mental illness. Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies. Open Med. Ann Intern Med. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Development and validation of the Assessment for Repeated Suicide.

Asia-Pacific Psychiatry. Suicide Intent Scale in the prediction of suicide. J Affect Disord. Sense of coherence and suicidality in suicide attempters: a prospective study. J Psychiatr Ment Health Nurs. Evaluating the predictive validity of suicidal intent and medical lethality in youth. Journal of Consulting and Clinical Psychology. Predictors of suicide attempt in early-onset, first-episode psychoses: a longitudinal month follow-up study.

J Clin Psychiatry. Ougrin D, Boege I. Brief report: the Self Harm Questionnaire: a new tool designed to improve identification of self harm in adolescents. J Adolesc. The suicide assessment scale: an instrument assessing suicide risk of suicide attempters. Eur Psychiatry. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale.

Karolinska Interpersonal Violence Scale predicts suicide in suicide attempters. A 2—4 year follow up of depressive symptoms, suicidal ideation, and suicide attempts among adolescent psychiatric inpatients. Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior.

Correlates of relative lethality and suicidal intent among deliberate self-harm patients. Suicide Life Threat Behav. Hopelessness and suicidal behavior. Keller F, Wolfersdorf M. Hopelessness and the tendency to commit suicide in the course of depressive disorders. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Harriss L, Hawton K. Suicidal intent in deliberate self-harm and the risk of suicide: the predictive power of the Suicide Intent Scale.

The ASQ is a set of four screening questions that takes 20 seconds to administer. Led by the NIMH, a multisite research study has now demonstrated that the ASQ is also a valid screening tool for adult medical patients. By enabling early identification and assessment of medical patients at high risk for suicide, the ASQ toolkit can play a key role in suicide prevention.

Suicide is a global public health problem and a leading cause of death across age groups worldwide. Suicide is also a major public health concern in the United States, with suicide ranking as the second leading cause of death among young people ages Even more common than death by suicide are suicide attempts and suicidal thoughts.

Early detection is a critical prevention strategy. The majority of people who die by suicide visit a healthcare provider within months before their death. This represents a tremendous opportunity to identify those at risk and connect them with mental health resources. Yet, most healthcare settings do not screen for suicide risk. In February , the Joint Commission, the accrediting organization for health care programs in hospitals throughout the United States, issued a Sentinel Event Alert recommending that all medical patients in all medical settings inpatient hospital units, outpatient practices, emergency departments be screened for suicide risk.

Using valid suicide risk screening tools that have been tested in the medical setting and with youth, will help clinicians accurately detect who is at risk and who needs further intervention. In another multisite research study was launched to validate the ASQ among adults. For medical settings, one of the biggest barriers to screening is how to effectively and efficiently manage the patients that screen positive.

Prior to screening for suicide risk, each setting will need to have a plan in place to manage patients that screen positive. The ASQ Toolkit was developed to assist with this management plan and to aid implementation of suicide risk screening and provide tools for the management of patients who are found to be at risk.

The Ask Suicide-Screening Questions ASQ toolkit is designed to screen medical patients ages 8 years and above for risk of suicide As there are no tools validated for use in kids under the age of 8 years, if suicide risk is suspected in younger children a full mental health evaluation is recommended instead of screening.

The ASQ is free of charge and available in multiple languages. For all patients, any other visitors in the room should be asked to leave the room during screening. Patients who screen positive for suicide risk on the ASQ should receive a brief suicide safety assessment BSSA conducted by a trained clinician e. The BSSA should be brief and guides what happens next in each setting. Any patient that screens positive, regardless of disposition, should be given the Patient Resource List.

For questions regarding toolkit materials or implementing suicide risk screening, please contact: Lisa Horowitz, PhD, MPH at horowitzl mail.