Protocol - Intensity of Suicidal Ideation (Continuum) - Adult

Description

The Scale for Suicide Ideation (SSI) is a 21-item, interviewer-administered scale that measures the current intensity of patients’ specific attitudes, behaviors, and plans to commit suicide on the day of the interview and during the time period that they were most suicidal. The first 5 items are screeners (wish to live, wish to die, and desire to attempt suicide), followed by 14 items to assess suicidal risk factors. The last 2 items capture previous suicide attempts. The respondent is first asked all questions about their suicidal ideation on the day of the interview and then queried about the most severe point of suicidal ideation.

Each item is rated on a 3-point scale ranging from 0 to 2 according to suicidal intensity. The SSI is scored by adding up the ratings (0-2) from the first 19 items.

Specific Instructions

This protocol includes questions that can potentially identify respondents who are at risk of suicide. Investigators implementing this protocol should consider developing a risk management plan specific to their study to ensure the safety of participants. The following links provide additional information and guidelines for suicide-related research:

ora.research.ucla.edu/OHRPP/Documents/Policy/8/Risk_of_Suicide.pdf

www.nimh.nih.gov/health/topics/suicide-prevention/issues-to-consider-in-intervention-research-with-persons-at-high-risk-for-suicidality.shtml

Availability

Available

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Protocol

Day of Interview		Time of Crisis/Most Severe Point of Illness
Today’s Date: ___ / ___ / ___		Approximate Date at Most Severe Point: ___ / ___ / ___
	I. Characteristics of Attitude Toward Living/Dying
( )	1. Wish to Live 0 Moderate to strong 1 Weak 2 None	( )
( )	2. Wish to Die 0 None 1 Weak 2 Moderate to strong	( )
( )	3. Reasons for Living/Dying 0 For living outweigh for dying 1 About equal 2 For dying outweigh for living	( )
( )	4. Desire to Make Active Suicide Attempt 0 None 1 Weak 2 Moderate to strong	( )
( )	5. Passive Suicidal Attempt 0 Would take precautions to save life 1 Would leave life/death to chance (e.g., carelessly crossing a busy street) 2 Would avoid steps necessary to save or maintain life (e.g., diabetic ceasing to take insulin)	( )
	If all four code entries for Items 4 and 5 are "0," skip Sections II, III, and IV.
	II. Characteristics of Suicide Ideation/Wish
( )	6. Time Dimension: Duration 0 Brief, fleeting periods 1 Longer periods 2 Continuous (chronic), or almost continuous	( )
( )	7. Time Dimension: Frequency 0 Rare, occasional 1 Intermittent 2 Persistent or continuous	( )
( )	8. Attitude Toward Ideation/Wish 0 Rejecting 1 Ambivalent; indifferent 2 Accepting	( )
( )	9. Control Over Suicidal Action/Acting Out Wish 0 Has sense of control 1 Unsure of control 2 Has no sense of control	( )
( )	10. Deterrents to Active Attempt (e.g., family, religion; possibility of serious injury if unsuccessful; irreversibility) 0 Would not attempt suicide because of a deterrent 1 Some concern about deterrents 2 Minimal or no concern about deterrents Indicate deterrents, if any:_________________	( )
( )	11. Reason for Contemplated Attempt 0 To manipulate the environment; get attention revenge 1 Combination of "0" and "2" 2 Escape, surcease, solve problems	( )
	III. Characteristics of Contemplated Attempt
( )	12. Method: Specificity/Planning 0 Not considered 1 Considered, but details not worked out 2 Details worked out/well formulated	( )
( )	13.Method: Availability/Opportunity 0 Method not available; no opportunity 1 Method would take time/effort; opportunity not readily available 2a Method and opportunity available 2b Future opportunity or availability of method anticipated	( )
( )	14. Sense of "Capability" to Carry Out Attempt 0 No courage, too weak, afraid, incompetent 1 Unsure of courage, competence 2 Sure of competence, courage	( )
( )	15. Expectancy/Anticipation of Actual Attempt 0 No 1 Uncertain, not sure 2 Yes
	IV. Actualization of Contemplated Attempt
( )	16.Actual Preparation 0 None 1 Partial (e.g., starting to collect pills) 2 Complete (e.g., had pills, razor, loaded gun)	( )
( )	17.Suicide Note 0 None 1 Started but not completed; only thought about 2 Completed	( )
( )	18. Final Acts in Anticipation of Death (e.g., insurance, will, gifts) 0 None 1 Thought about or made some arrangements 2 Made definite plans or completed arrangements	( )
( )	19. Deception/Concealment of Contemplated Attempt (Refers to communication of ideation to interviewing clinician) 0 Revealed ideas openly 1 Held back on revealing 2 Attempted to deceive, conceal, lie	( )
	V. Background Factors
( )	20. Previous Suicide Attempts 0 None 1 One 2 More than one	( )
( )	21. Intent to Die Associated with Last Attempt (if N/A enter "8") 0 Low 1 Moderate; ambivalent, unsure 2 High	( )

Scoring

Each item is rated on a 3-point scale ranging from 0 to 2 according to suicidal intensity. The SSI is scored by adding up the ratings (0-2) from the first 19 items.

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

The PhenX Working Group acknowledges these questions can be administered by the interviewer in a computerized or non-computerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Interviewer-administered questionnaire

Lifestage

Adult

Participants

Adults, ages 17 and older

Selection Rationale

The Scale for Suicide Ideation (SSI) is a brief, low-burden questionnaire that is widely used in clinical trials that focus on suicidal ideation. The SSI is sensitive to change, with good convergent validity, interrater reliability, internal consistency, and predictive validity for suicide attempts and death by suicide. Additionally, the SSI questions correspond to U.S. Food and Drug Administration definitions of suicidal ideation (Guidance for Industry Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials Office of Communications, Division of Drug Information Center for Drug Evaluation and Research Food and Drug Administration, 2012).

Language

English

Standards

Standard	Name	ID	Source
Human Phenotype Ontology	Suicidal Ideation	HP:0031599	HPO
caDSR Form	PhenX PX640202 - Intensity Of Suicidal Ideation Continuum Adult	6232758	caDSR Form

Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

The Scale for Suicide Ideation (SSI)

Source

Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343-352.

The Scale for Suicide Ideation (SSI) is not proprietary and is available to researchers from Dr. Aaron Beck: abeck@mail.med.upenn.edu.

General References

Beck, A. T., Brown, G. K., & Steer, R. A. (1997). Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Behavior Research and Therapy, 35(11), 1039-1046.

Beck, A. T., Brown, G. K., Steer, R. A., Dahlsgaard, K. K., & Grisham, J. R. (1997). Suicide ideation at its worst point: A predictor of eventual suicide in psychiatric outpatients. Suicide and Life-Threatening Behavior 29(1), 1-9.

Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343-352.

Center for Drug Evaluation and Research (CDER). (2012). Guidance for industry suicidal ideation and behavior: Prospective assessment of occurrence in clinical trials. Rockville, MD: U.S. Department of Health and Human Services, U.S. Food and Drug Administration.

Protocol ID

640202

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX640202_Actual_Suicide_Preparation_Current
	PX640202170000	Actual Preparation	N/A
PX640202_Actual_Suicide_Preparation_Worst
	PX640202390000	Actual Preparation	N/A
PX640202_Attitude_Toward_Ideation_Current
	PX640202080000	Attitude Toward Ideation/Wish	N/A
PX640202_Attitude_Toward_Ideation_Worst
	PX640202300000	Attitude Toward Ideation/Wish	N/A
PX640202_Control_Over_Suicidal_Action_Current
	PX640202090000	Control Over Suicidal Action/Acting Out Wish	N/A
PX640202_Control_Over_Suicidal_Action_Worst
	PX640202310000	Control Over Suicidal Action/Acting Out Wish	N/A
PX640202_Desire_Active_Suicide_Attempt_Current
	PX640202040000	Desire to Make Active Suicide Attempt	N/A
PX640202_Desire_Active_Suicide_Attempt_Worst
	PX640202260000	Desire to Make Active Suicide Attempt	N/A
PX640202_Deterrents_Active_SuicideAttempt_Current
	PX640202100000	Deterrents to Active Attempt (e.g., family, more religion; possibility of serious injury if unsuccessful; irreversibility) show less	N/A
PX640202_Deterrents_Active_SuicideAttempt_Indicate_Current
	PX640202110000	Deterrents to Active Attempt (e.g., family, more religion; possibility of serious injury if unsuccessful; irreversibility) Indicate deterrents, if any: show less	N/A
PX640202_Deterrents_Active_SuicideAttempt_Indicate_Worst
	PX640202330000	Deterrents to Active Attempt (e.g., family, more religion; possibility of serious injury if unsuccessful; irreversibility) Indicate deterrents, if any: show less	N/A
PX640202_Deterrents_Active_SuicideAttempt_Worst
	PX640202320000	Deterrents to Active Attempt (e.g., family, more religion; possibility of serious injury if unsuccessful; irreversibility) show less	N/A
PX640202_Expectancy_Anticipation_Suicide_Attempt_Current
	PX640202160000	Expectancy/Anticipation of Actual Attempt	N/A
PX640202_Expectancy_Anticipation_Suicide_Attempt_Worst
	PX640202380000	Expectancy/Anticipation of Actual Attempt	N/A
PX640202_Intent_Die_LastSuicideAttempt_Current
	PX640202220000	Intent to Die Associated with Last Attempt	N/A
PX640202_Intent_Die_LastSuicideAttempt_Worst
	PX640202440000	Intent to Die Associated with Last Attempt	N/A
PX640202_Passive_Suicidal_Attempt_Current
	PX640202050000	Passive Suicidal Attempt	N/A
PX640202_Passive_Suicidal_Attempt_Worst
	PX640202270000	Passive Suicidal Attempt	N/A
PX640202_Previous_Suicide_Events
	PX640202430000	Previous Suicide Attempts	N/A
PX640202_Previous_Suicide_Events
	PX640202210000	Previous Suicide Attempts	N/A
PX640202_Reasons_Contemplated_Suicide_Attempt_Current
	PX640202120000	Reason for Contemplated Attempt	N/A
PX640202_Reasons_Contemplated_Suicide_Attempt_Worst
	PX640202340000	Reason for Contemplated Attempt	N/A
PX640202_Reasons_For_LivingDying_Current
	PX640202030000	Reasons for Living/Dying	N/A
PX640202_Reasons_For_LivingDying_Worst
	PX640202250000	Reasons for Living/Dying	N/A
PX640202_Sense_Of_Suicide_Capability_Current
	PX640202150000	Sense of Capability to Carry Out Attempt	N/A
PX640202_Sense_Of_Suicide_Capability_Worst
	PX640202370000	Sense of Capability to Carry Out Attempt	N/A
PX640202_Suicide_Deception_Contemplated_Attempt_Current
	PX640202200000	Deception/Concealment of Contemplated Attempt	N/A
PX640202_Suicide_Deception_Contemplated_Attempt_Worst
	PX640202420000	Deception/Concealment of Contemplated Attempt	N/A
PX640202_Suicide_Final_Acts
	PX640202410000	Final Acts in Anticipation of Death (e.g., more insurance, will, gifts) show less	N/A
PX640202_Suicide_Final_Acts
	PX640202190000	Final Acts in Anticipation of Death (e.g., more insurance, will, gifts) show less	N/A
PX640202_Suicide_Method_Availability_Opportunity_Current
	PX640202140000	Method: Availability/Opportunity	N/A
PX640202_Suicide_Method_Availability_Opportunity_Worst
	PX640202360000	Method: Availability/Opportunity	N/A
PX640202_Suicide_Method_Specificity_Planning_Current
	PX640202130000	Method: Specificity/Planning	N/A
PX640202_Suicide_Method_Specificity_Planning_Worst
	PX640202350000	Method: Specificity/Planning	N/A
PX640202_Suicide_Note_Current
	PX640202180000	Suicide Note	N/A
PX640202_Suicide_Note_Worst
	PX640202400000	Suicide Note	N/A
PX640202_Time_Dimension_Duration_Current
	PX640202060000	Time Dimension: Duration	N/A
PX640202_Time_Dimension_Duration_Worst
	PX640202280000	Time Dimension: Duration	N/A
PX640202_Time_Dimension_Frequency_Current
	PX640202070000	Time Dimension: Frequency	N/A
PX640202_Time_Dimension_Frequency_Worst
	PX640202290000	Time Dimension: Frequency	N/A
PX640202_Wish_To_Die_Current
	PX640202020000	Wish to Die	N/A
PX640202_Wish_To_Die_Worst
	PX640202240000	Wish to Die	N/A
PX640202_Wish_To_Live_Current
	PX640202010000	Wish to Live	N/A
PX640202_Wish_To_Live_Worst
	PX640202230000	Wish to Live	N/A

Suicide

Measure Name

Intensity of Suicidal Ideation (Continuum)

Release Date

November 21, 2014

Definition

A questionnaire to measure the degree of suicidal ideation.

Purpose

Suicidal ideation can indicate an increased risk for suicidal attempts. This measure can be used to determine levels of suicidal risk and aid in making clinical decisions about care. In contrast to the PhenX measure Classification of Suicidal Ideation and Suicidal Behavior, which distinguishes and classifies suicidal ideation and behavior separately, this measure considers suicidal ideation existing as a continuous scale within a single construct.

Keywords

suicide, Suicide intent, Suicide Ideation, suicidal ideation, Wish to live, Wish to die, Reason for living, Suicidal Ideation Questionnaire-Junior, SIQ-JR, Scale for Suicide Ideation, SSI, proprietary

Measure Protocols

Protocol ID	Protocol Name
640201	Intensity of Suicidal Ideation (Continuum) - Adolescent
640202	Intensity of Suicidal Ideation (Continuum) - Adult

Publications

Clifford, T. (2024) Social Determinants of Health Journal of Perianesthesia Nursing. 2024 April; 39(2): 329-330. doi: 10.1016/j.jopan.2024.01.008

Goodman, M., et al. (2020) Group (?Project Life Force?) versus individual suicide safety planning: A randomized clinical trial. Contemporary Clinical Trials Communications. 2020 January; 17: 100520. doi: 10.1016/j.conctc.2020.100520

Bryan, C. J., et al. (2019) The PRImary care Screening Methods (PRISM) study: Rationale and design considerations. Contemporary Clinical Trials. 2019 September; 84: 105823. doi: 10.1016/j.cct.2019.105823