Protocol - Lethality of Suicide Attempts
- Classification of Suicidal Ideation and Suicidal Behavior - Adolescent - Current
- Classification of Suicidal Ideation and Suicidal Behavior - Adolescent - Epidemiology
- Classification of Suicidal Ideation and Suicidal Behavior - Adolescent - Lifetime
- Classification of Suicidal Ideation and Suicidal Behavior - Adolescent - Since Last Visit
- Classification of Suicidal Ideation and Suicidal Behavior - Adult - Current
- Classification of Suicidal Ideation and Suicidal Behavior - Adult - Epidemiology
- Classification of Suicidal Ideation and Suicidal Behavior - Adult - Lifetime
- Classification of Suicidal Ideation and Suicidal Behavior - Adult - Since Last Visit
- Intensity of Suicidal Ideation (Continuum) - Adolescent
- Intensity of Suicidal Ideation (Continuum) - Adult
- Non-suicidal Self Injury
- Suicidal Intent of Suicide Attempts
Description
The Beck Lethality Scales includes eight items that measure the medical lethality of previous suicide attempts (e.g., shooting, jumping, and drug overdose). Each scale is rated from 0 to 10, based on an examination of the patient’s physical condition on admission, review of the medical charts, and consultation with the attending physician.
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
Availability
Protocol
BECK LETHALITY SCALES
Instructions to interviewer: These scales establish the lethality of patients’ suicide attempt(s). Use all available information to establish the lethality of each previous suicide attempt.
Enter the date (MM/YY) of each suicide attempt, then code the lethality of each suicide attempt, starting with the MOST recent suicide attempt. If the patient used more than one method, code each method, beginning with the MOST lethal. (Example: on 12/1/95, a patient attempted suicide by consuming a liter of grain alcohol and a gunshot to the abdomen. This would be coded as date: 12/95; primary code 0306; secondary code 0104.)
Listing of Lethality Codes
LETH 01 Lethality Scale for Coma-Producing Drugs
00[ ]Fully conscious and alert
01[ ]Conscious but sleepy
02[ ]Lethargic-speech and motility retarded but responsive to questions; intellectual functions intact
03[ ]Lethargic with diminution in intellectual ability
04[ ]Severely blunted, dull, or lacking in vigor, but awake and somewhat responsive
05[ ]Asleep but easily aroused
06[ ]Comatose-withdrawal from painful stimuli; reflexes intact
07[ ]Comatose-no withdrawal from painful stimuli; most reflexes intact; no respiratory or circulatory depression
08[ ]Comatose-most reflexes absent; no respiratory or circulatory depression
09[ ]Comatose-all reflexes absent; respiratory depression with cyanosis or circulatory failure and shock both
10[ ]Death
99[ ]Does not apply
LETH 02 Lethality for Non-Coma-Producing Drugs
00[ ]No damage
02[ ]Minimal medical consequences or treatment
04[ ]Some injury (e.g. mouth burns) and treatment in emergency room or on out-patient basis (e.g. gastric lavage)
06[ ]Injury sufficient for hospitalization-vital signs and level of consciousness may be affected
08[ ]Major systemic effects-such as G.I. perforation, renal failure, blood hemolysis, or shock; vital signs unstable
10[ ]Death
99[ ]Does not apply
LETH 03 Lethality Scale for Shooting
00[ ]No Damage
02[ ]Flesh wounds with powder burns
04[ ]Bullet lodged in extremity-minor bleeding
06[ ]Bullet in abdomen or chest-major bleeding; vital signs unstable
08[ ]Bullet to head area
10[ ]Death
99[ ]Does not apply
LETH 04 Lethality Scale for Burning
00[ ]No damage
02[ ]First-degree burns
04[ ]Second-degree burns
06[ ]Third-degree burns under 20% body area
08[ ]Third-degree burns over 60% body area
10[ ]Death
99[ ]Does not apply
LETH 05 Lethality Scale for Drowning
00[ ]No damage
02[ ]Conscious-some respiratory distress but no resuscitation needed
04[ ]Conscious-minimal to moderate efforts at resuscitation needed
06[ ]Conscious-extensive efforts at resuscitation needed
08[ ]Unconscious-massive efforts at resuscitation necessary for revival
10[ ]Death
99[ ]Does not apply
LETH 06 Lethality Scale for Cutting
00[ ]Surface scratches; none or minor bleeding; little or no wound care required.
02[ ]Moderate bleeding with clotting before significant blood loss occurs; simple wound care required
04[ ]Bleeding of major vessel; danger of considerable blood loss without surgical intervention-suturing necessary but no transfusion; vital areas intact and no change in vital signs; care on out-patient basis
06[ ]Extensive blood loss; suturing, blood replacement and tendon repair required; wound may be to head, thorax, or abdomen but vital organs intact and vital signs stable; recovery with in-patient care expected
08[ ]Extensive blood loss with shock; insult to vital areas with change in vital signs; recovery with in-patient care doubtful
10[ ]Death
99[ ]Does not apply
LETH 07 Lethality Scale for Jumping
00[ ]Minor bruises only no treatment necessary
02[ ]Sprains or minor injuries-no bone, ligament, or tendon damage; no internal bleeding, tissue or brain damage
04[ ]Extremities fractured-casting necessary but no major tendon repair and complete recovery expected
06[ ]Major one and/or tendon damage in multiple areas-internal bleeding; some residual impairment expected but not in vital areas
08[ ]Major damage to vital area (skull, neck, spinal column); paralysis expected
10[ ]Death
99[ ]Does not apply
LETH 08 Lethality Scale for Hanging
00[ ]No damage
02[ ]Simple rope burns
04[ ]More extensive injuries with treatment on out-patient basis
06[ ]Hospitalization and resuscitation required
08[ ]Paralysis or other spinal cord injury
10[ ]Death
99[ ]Does not apply
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 in a computerized or noncomputerized 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
Adolescent, Adult
Participants
Adolescents and adults, ages 12 and older
Selection Rationale
The Beck Lethality Scales are generally accepted by researchers and have demonstrated interrater reliability and convergent validity.
Language
English
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Human Phenotype Ontology | Suicidal Ideation | HP:0031589 | HPO |
| caDSR Form | PhenX PX640401 - Lethality Of Suicide Attempts | 6232996 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
Protocol Name from Source
The Beck Lethality Scales
Source
Beck, A. T., Beck, R., & Kovacs, M. (1975). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry, 132(3), 285-287.
General References
Lester, D., & Beck, A. T. (1975). Attempted suicide: Correlates of increasing medical lethality. Psychological Reports, 37(3 PT 2), 1236-1238.
Spokas, M., Wenzel, A., Brown, G. K., & Beck, A. T. (2012). Characteristics of individuals who make impulsive suicide attempts. Journal of Affective Disorders 136(3), 1121-1125.
Weissman, A. D., & Worden, J. W. (1986). Risk-rescue rating in suicide assessment. In A. T. Beck, H. L. P. Resnik, & D. J. Lettieri (Eds). The prediction of suicide (2nd ed., pp. 193-213). Philadelphia: Charles Press.
Protocol ID
640401
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX640401_Suicide_Attempt1_Month | ||||
| PX640401010000 | Month of suicide attempt 1 (most recent) | N/A | ||
| PX640401_Suicide_Attempt1_Primary_Lethality_Code | ||||
| PX640401030000 | Suicide attempt 1, first suicide lethality more | N/A | ||
| PX640401_Suicide_Attempt1_Secondary_Lethality_Code | ||||
| PX640401040000 | Suicide attempt 1, second suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt1_Tertiary_Lethality_Code | ||||
| PX640401050000 | Suicide attempt 1, third suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt1_Year | ||||
| PX640401020000 | Year of suicide attempt 1 (most recent) | N/A | ||
| PX640401_Suicide_Attempt2_Month | ||||
| PX640401060000 | Month of suicide attempt 2 | N/A | ||
| PX640401_Suicide_Attempt2_Primary_Lethality_Code | ||||
| PX640401080000 | Suicide attempt 2, first suicide lethality more | N/A | ||
| PX640401_Suicide_Attempt2_Secondary_Lethality_Code | ||||
| PX640401090000 | Suicide attempt 2, second suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt2_Tertiary_Lethality_Code | ||||
| PX640401100000 | Suicide attempt 2, third suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt2_Year | ||||
| PX640401070000 | Year of suicide attempt 2 | N/A | ||
| PX640401_Suicide_Attempt3_Month | ||||
| PX640401110000 | Month of suicide attempt 3 | N/A | ||
| PX640401_Suicide_Attempt3_Primary_Lethality_Code | ||||
| PX640401130000 | Suicide attempt 3, first suicide lethality more | N/A | ||
| PX640401_Suicide_Attempt3_Secondary_Lethality_Code | ||||
| PX640401140000 | Suicide attempt 3, second suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt3_Tertiary_Lethality_Code | ||||
| PX640401150000 | Suicide attempt 3, third suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt3_Year | ||||
| PX640401120000 | Year of suicide attempt 3 | N/A | ||
| PX640401_Suicide_Attempt4_Month | ||||
| PX640401160000 | Month of suicide attempt 4 | N/A | ||
| PX640401_Suicide_Attempt4_Primary_Lethality_Code | ||||
| PX640401180000 | Suicide attempt 4, first suicide lethality more | N/A | ||
| PX640401_Suicide_Attempt4_Secondary_Lethality_Code | ||||
| PX640401190000 | Suicide attempt 4, second suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt4_Tertiary_Lethality_Code | ||||
| PX640401200000 | Suicide attempt 4, third suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt4_Year | ||||
| PX640401170000 | Year of suicide attempt 4 | N/A | ||
| PX640401_Suicide_Attempt5_Month | ||||
| PX640401210000 | Month of suicide attempt 5 | N/A | ||
| PX640401_Suicide_Attempt5_Primary_Lethality_Code | ||||
| PX640401230000 | Suicide attempt 5, first suicide lethality more | N/A | ||
| PX640401_Suicide_Attempt5_Secondary_Lethality_Code | ||||
| PX640401240000 | Suicide attempt 5, second suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt5_Tertiary_Lethality_Code | ||||
| PX640401250000 | Suicide attempt 5, third suicide lethality code | N/A | ||
| PX640401_Suicide_Attempt5_Year | ||||
| PX640401220000 | Year of suicide attempt 5 (most recent) | N/A | ||
Measure Name
Lethality of Suicide Attempts
Release Date
November 21, 2014
Definition
A rating scale to assess the degree of medical lethality of a suicide attempt.
Purpose
Previous suicide attempts of high lethality are associated with increased future suicide risk and a greater determination to die.
Keywords
suicide, Suicide attempts, Self-injury, Lethality
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 640401 | Lethality of Suicide Attempts |
Publications
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