Validity of the modular assessment of risk for imminent suicide in predicting short‐term suicidality

Abstract

Objective The Modular Assessment of Risk for Imminent Suicide (MARIS) is a clinical assessment tool, consisting of four modules assessing (1) a pre‐suicidal cognitive‐affective state (Module 1); (2) patients’ attitudes toward suicide (Module 2); (3) clinicians’ assessment of suicide risk factors (Module 3); and (4) clinicians’ emotional responses to patients (Module 4) that assesses short‐term suicide risk. Initial evidence provided evidence for its reliability and concurrent validity. The present study extended these findings by examining the MARIS’s predictive validity in relation to suicidal thoughts and behaviors at one‐month follow‐up. Methods A sample of 1039 psychiatric patients (378 inpatients, 661 outpatients) and their clinicians (N = 144) completed a battery of measures at baseline; 670 patients completed the one‐month follow‐up assessment. Results MARIS total scores predicted suicidal thoughts and behaviors at one‐month follow‐up, even after controlling for baseline suicidal thoughts and behaviors. Moreover, both Module 1 and the Distress subscale of Module 4 were uniquely associated with suicidal thoughts and behaviors at one‐month follow‐up, controlling for baseline suicidal thoughts and behaviors. Modules 2 and 3, on the other hand, exhibited poor internal consistency. Conclusion Overall, both patient‐ and clinician‐rated indices are uniquely predictive of suicidal thoughts and behaviors at one‐month follow‐up, highlighting the need for integrating clinicians’ emotional responses into suicide risk assessment. Pending replication and extension of these findings in external samples, a briefer, two‐module version of MARIS (MARIS‐2) may be such an integrative, psychometrically sound, and clinically useful instrument that can be utilized to assess short‐term suicide risk.

Imminent and Short-Term Risk of Death by Suicide in 7,000 Acutely Admitted Psychiatric Inpatients

“…30 It is compatible with elements of the proposed Suicide Crisis Syndrome (SCS), including excessive rumination and emotional pain, and predicted suicide within 7 days. SCS has been linked to pre-suicidal states, but appears to be independent of expressed suicidal ideation in previous studies 33,34,43 as well as in the current study. This study underscores the importance of addressing discrepancies between "what a person says and what a person does" 24 and placing more emphasis on clinically assessed depth of depressed mood.…”

“…SCS has thus far been tested against only proxy variables for suicide death such as ideation, attempts, and behavior and not completed suicide. 23,34 In sum, risk factors such as a diagnosis of depressive disorder, suicidal ideation, and suicide attempts the first months to years after assessment have been studied extensively, while clinically useful data on imminent risk still appear to be lacking.…”

Associations between long-term and near-term stressful life events, suicide crisis syndrome, and suicidal ideation.

“…The similarity of the associations between stressful life events, SCS, and suicide attempts is also notable. Namely, the SCS has demonstrated consistent and strong associations with suicide attempts in the short-term (i.e., within a 1-month follow-up period; Barzilay et al, 2020;Bloch-Elkouby et al, 2020;Rogers et al, 2021;Yaseen et al, 2019); likewise, stressful life events demonstrate relatively stronger associations with suicidal behavior than with suicidal ideation (McFeeters et al, 2015). Accordingly, it is plausible that the SCS may be a mediator of the association between recent stressors and suicide attempts.…”

“…Such narratives may make these individuals more prone to acute suicidal states, such as the suicide crisis syndrome (SCS), within the context of numerous and/or severe stressors. The SCS is a presuicidal cognitive–affective state, proposed for inclusion in standardized classification systems as a suicide-specific diagnosis (e.g., the Diagnostic and Statistical Manual for Mental Disorders [DSM]; American Psychiatric Association, 2013), that comprises feelings of entrapment, affective disturbances, loss of cognitive control, hyperarousal, and social withdrawal (Schuck et al, 2019) and has been linked to imminent suicidal behavior (i.e., suicide attempts within 1 month; Barzilay et al, 2020; Galynker et al, 2017; Rogers et al, 2021; Yaseen et al, 2019). Importantly, the SCS does not rely on the explicit disclosure of suicidal ideation or intent, which may or may not be present.…”

Perceived clinical utility of the suicide crisis syndrome: A multisite pilot study.

“…Specifically, the SCS is composed of five criteria: a pervasive feeling of frantic hopelessness or entrapment, affective disturbance (i.e., emotional pain, rapid spikes of negative emotions, extreme anxiety, anhedonia), loss of cognitive control (i.e., rumination, cognitive rigidity, ruminative flooding, failed thought suppression), overarousal (i.e., agitation, hypervigilance, irritability, insomnia), and social withdrawal (i.e., reduction in activity, evasive communication; Rogers et al, 2017; Schuck et al, 2019). Evidence to date suggests that the SCS has demonstrated a unidimensional factor structure (Barzilay et al, 2020; Bloch-Elkouby et al, 2020; Yaseen et al, 2019), convergent and discriminant validity with other symptoms of psychopathology and suicidality (Barzilay et al, 2020; Bloch-Elkouby et al, 2021; Calati et al, 2020; Cohen et al, 2019; Galynker et al, 2017; Otte et al, 2020; Pia et al, 2020), and incremental and predictive validity in relation to future suicide attempts, that is, within a 1-month follow-up (Barzilay et al, 2020; Bloch-Elkouby et al, 2021; Rogers et al, 2021; Yaseen et al, 2019). Notably, the SCS demonstrated incremental validity when assessed alongside suicidal ideation (SI) in predicting suicidal behavior at 1-month follow-up.…”