Limitations of a single-item assessment of suicide attempt history: Implications for standardized suicide risk assessment.

Abstract

Although a suicide attempt history is among the single best predictors of risk for eventual death by suicide, little is known about the extent to which reporting of suicide attempts may vary by assessment type. The current study aimed to investigate the correspondence between suicide attempt history information obtained via a single-item self-report survey, multi-item self-report survey, and face-to-face clinical interview. Data were collected among a high-risk sample of undergraduates (N = 100) who endorsed a past attempt on a single-item prescreening survey. Participants subsequently completed a multi-item self-report survey, which was followed by a face-to-face clinical interview, both of which included additional questions regarding the timing and nature of previous attempts. Even though 100% of participants (n = 100) endorsed a suicide attempt history on the single-item prescreening survey, only 67% (n = 67) reported having made a suicide attempt on the multi-item follow-up survey. After incorporating ancillary information obtained from the in-person interview, 60% of participants qualified for a CDC-defined suicide attempt. Of the 40% who did not qualify for a CDC-defined suicide attempt, 30% instead qualified for no attempt, 7% an aborted attempt, and 3% an interrupted attempt. These findings suggest that single-item assessments of suicide attempt history may result in the misclassification of prior suicidal behaviors. Given that such assessments are commonly used in research and clinical practice, these results emphasize the importance of utilizing follow-up questions and assessments to improve precision in the characterization and assessment of suicide risk.

The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research.

“…Additionally, meta-analytic models with suicide risk and/or dichotomous attempts as the outcome variable generally included fewer samples and/or smaller N s—this may, in part, explain the inconsistent findings. Nevertheless, to enhance the variance of the outcome measure and statistical power, it is recommended that future studies use a continuous outcome (i.e., number of attempts), precise definitions of suicide-related terms (e.g., Crosby, Ortega, & Melanson, 2011), and response options that allow for nuanced reporting of suicidal behavior (see Hom, Joiner, & Bernert, 2015 and Millner, Lee, & Nock, 2015 for discussions of the limintations of single-item assessments of attempt history). It may also be useful for studies to employ the same suicidal symptom measures to enhance interpretability of meta-analytic findings (Batterham et al, 2015).…”

The clinical application of suicide risk assessment: A theory‐driven approach

“…Additionally, Millner, Lee, and Nock () discussed the limitations of single‐item assessments of suicide ideation and attempts (e.g., misclassification); however, the items used in their study required a dichotomous response (yes/no), and the outcome was lifetime incidence of suicide ideation. Similarly, Hom, Joiner, and Bernert () discussed the limitations of single‐item, yes/no assessments of suicide attempt history (e.g., misclassification) and encourage precision of language (e.g., operational definitions) when asking initial and follow‐up questions of this nature. The items used in the current study assessed suicide ideation‐related outcomes during a more immediate time frame, allowed for more variability in responses, and used language that was likely clear to participants (i.e., face valid), which may have addressed some of the limitations associated with studies that use single‐item assessments of suicide‐related variables.…”

Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model

“…An additional limitation of this study is that, although the SBQ-R is a psychometrically sound assessment of suicide risk [41,45], there are issues inherent in self-report of suicide risk, including the possibility of misclassification [68,69]. Moving forward, research is needed to triangulate suicide risk assessment methodologies (e.g., self-report, clinician interview, behavioral tasks).…”