Correction: Emergency Room Validation of the Revised Suicide Trigger Scale (STS-3): A Measure of a Hypothesized Suicide Trigger State

Abstract

Background:The Suicide Trigger Scale (STS) was designed to measure the construct of an affective 'suicide trigger state.' This study aims to extend the inpatient setting validation study of the original Suicide Trigger Scale version 2 to the revised Suicide Trigger Scale version 3 (STS-3) in an acute psychiatric emergency room setting. Methods:The 42-item STS-3 and a brief psychological test battery were administered to 183 adult psychiatric patients with suicidal ideation or attempt in the psychiatric emergency room, and re-administered to subjects at 1 year follow up. Factor analysis, linear and logistic regressions were used to examine construct structure, divergent and convergent validity, and construct validity, respectively. Results:The STS-3 demonstrated strong internal consistency (Cronbach's alpha 0.94). Factor analysis yielded a three-factor solution, which explained 43.4% of the variance. Principal axis factor analysis was used to identify three reliable subscales: Frantic Hopelessness, Ruminative Flooding, and Near-Psychotic Somatization (Cronbach's alphas 0.90, 0.80, and 0.76, respectively). Significant positive associations were observed between Frantic Hopelessness and BSI depression and anxiety subscales, between Ruminative Flooding and BSI anxiety and paranoia subscales, and Near Psychotic Somatization and BSI somatization subscales. Suicidal subjects with suicide attempt history had mean scores 7 points higher than those without history of suicide attempts. Frantic hopelessness was a significant predictor of current suicide attempt when only attempts requiring at least some medical attention were considered. Conclusion:The STS-3 measures a distinct clinical entity, provisionally termed the 'suicide trigger state.' Scores on the STS-3 or select subscales appear to relate to degree of suicidality in terms of severity of ideation, history of attempt, and presence of substantive current attempts. Further study is required to confirm the factor structure and better understand the nature of these relations.

Suicide Crisis Syndrome: A systematic review

“…A total of 37 articles from 2010 to 2022 were identified by search criteria and considered in detail. Sixteen of these articles were excluded from further analysis because of the following reasons: eight studies used the Suicide Trigger Scale as an instrument (Cohen et al, 2018;Hawes et al, 2017;Høyen et al, 2021Høyen et al, , 2022Yaseen et al, 2010Yaseen et al, , 2012Yaseen et al, , 2014Yaseen et al, , 2016, three studies only evaluated single dimensions of the SCS (Li et al, 2017;Rogers, Cao, et al, 2021;Yaseen et al, 2017), three studies did not assess STB as an outcome (Bloch-Elkouby, Gorman, Molaie et al, 2019;Ying et al, 2021), and two studies were not written in English (Chang et al, 2022;Vespa et al, 2021). Twenty-one articles were included in the systematic review (see Table 3).…”

“…In early studies, the SCS syndrome was labeled "suicide trigger state" (STS) consisting of three components (frantic hopelessness, ruminative flooding, and panic dissociation). To measure the hypothesized construct of a suicide trigger state preceding a suicide attempt, Galynker and his team developed a self-report instrument, the Suicide Trigger Scale (STS-2), derived from a first unpublished questionnaire (STS-1, see Yaseen et al, 2010) and followed by a third, revised version of the questionnaire (STS-3;Yaseen et al, 2012). A shortened version, the Suicide Trigger Scale Short Form (STS-SF; Hawes et al, 2017), was created with eight items including the factors of entrapment and ruminative flooding.…”