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Measurement Resources for Suicide Prevention Research


SPRINT-Assistance in Selecting Suicide Indices Specialty Tool (S-ASSIST)

The SPRINT-Assistance in Selecting Suicide Indices Specialty Tool (S-ASSIST) is a summary table outlining the broad facets of suicidal thoughts and behaviors (i.e., not risk factors) that are captured within and across measures recommended by the working group of the PhenX Suicide Specialty Collection (with the addition of the PHQ-9).

When conducting research related to suicidal thoughts and/or behaviors, investigators are inherently tasked with choosing the measure(s) to assess these constructs. Choosing a measure often reflects a mixture of identifying the optimal measure of constructs of interest with practical considerations of what data sources are available. 

In terms of selecting from recommended measures, Federal agencies such as the Department of Veteran Affairs (e.g., HSR&D) and the National Institutes of Health (e.g., NIMH) have recommended the use of common data elements such as the PhenX Suicide Specialty Collection, and language related to common data elements is routinely included within Requests for Applications that are focused on suicide prevention broadly. The PhenX Suicide Specialty Collection is an outstanding resource which provides recommended data collection protocols that were devised by a working consensus group of suicide experts. These protocols broadly assess suicidal thoughts and behaviors (and also include risk factors for suicide). Each protocol includes a variety of pertinent information, e.g. a description of the measure, the actual measure, instructions for administration, relevant citations/sources, as well as additional information and guidelines for suicide-related research.

However, the PhenX Suicide Specialty Collection can be a bit daunting, and it can be difficult to evaluate which measures capture specific suicide domains and facets (sub domains) of interest. For instance, in terms of domains, questions can refer to whether a specific facet (e.g., active preparation for an attempt) occurred during a specific time frame (and independent of whether a participant attempted suicide within that time frame), or whether it was event-based (e.g., present for a specific attempt that is being referenced or assessed). Thus, our goal was to increase understanding of what facets of suicide ideation and behavior are captured within and across measures already recommended/collected by key federal agencies.

Although primarily focused on the measures included in the PhenX Suicide Specialty Collection, the present analysis also was undertaken with the awareness of the practical constraints encountered by VHA researchers interested in utilizing data already collected during routine care. Notably, The Patient Health Questionnaire (PHQ-9) and the 6 item Columbia Suicide Severity Scale Rating screener (CSSRS) are measures that are currently being collected broadly as part of service delivery in VHA and are stored in the Corporate Data Warehouse. The CSSRS is contained within the PhenX Suicide Specialty Collection, whereas the PHQ-9 is not. Thus, we supplemented our review of measures included within the PhenX (i.e., the CSSRS and others) by also including the PHQ-9 in developing the resource below.

Specifically, we created the “SPRINT-Assistance in Selecting Suicide Indices Specialty Tool” (S-ASSIST) which is a summary table delineating which broad facets of suicidal thoughts and behaviors (i.e., not risk factors) are captured within and across measures within the PhenX Suicide Specialty Collection (with the addition of the PHQ-9). This breakdown of measures is intended to provide information regarding how to access each protocol/measure, the administration type, and most importantly the potential domains and facets of suicidal ideation/behavior assessed. This resource is intended to serve as a guide for researchers to determine which measures to initially consider, depending on their suicide domain/facet of interest.

Below we provide suicide facets (and examples that encompass these facets) within each domain. For this resource, we focused on more direct questions that assess these facets, instead of other, potentially periphery questions that might be part of the overall construct or that are viewed as risk factors (e.g., hopelessness). Given that the field often lacks agreed upon definitions (e.g., suicide planning), our categorizations for specific facets should be viewed as only one resource.  In the future, the field would benefit from a fine-grained approach to obtaining consensus definitions of key domains and facets for specific types of suicidal thoughts and behaviors. 

S-ASSIST Domains and Suicide Facets Covered (See Tab “Examples of Facets w/in Domains):

Domain A-Presence of Suicide Facets Overall (Not Paired with a Specific Suicide Attempt)

Facet

Example

Column

Passive Suicidal Ideation

E.g., Thoughts/wishes to die; sleep and not wake up

C

Active Suicidal Ideation

E.g., Thoughts of killing oneself/committing suicide (note later term not recommended to use)

D

Suicide Plan-Thoughts

E.g., Making a plan/working out details

E

Active Preparations for an Attempt-Behaviors

E.g., Collecting pills; purchasing a gun; giving away valuables/writing a note

F

Suicide Attempt

E.g., Made a suicide attempt; attempt to kill oneself with at least w/ some intent to die

G

Domain B-Presence of Suicide Facets Paired with a Specific Suicide Attempt (Suicide Attempt Characteristics; SAC)

Facet

Example

Column

SAC: Active Preparations for an Attempt-Behaviors

E.g., “Active preparation”; suicide note

I

SAC: Self-Perception of Fatality/Lethality of attempt

E.g., Perceptions of probability of death/belief that the methods used would be lethal

J

SAC: Injuries/Medical Attention/Lethality

E.g., Degree of medical lethality; presence of injuries/poisoning; medical attention required

K

SAC:  Methods for an Attempt

E.g., Prescriptions, poisons, firearms etc. 

L

Tool Notes:

N/A- not applicable (e.g., did not assess a specific suicide attempt; only assessed a specific suicide attempt)

*further information/qualifications about facet

Download SPRINT ASSIST Tool




Other Resources Regarding Measures for Suicide Prevention Research

1. Name: Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe

a. Brief Source: National Action Alliance for Suicide Prevention (2018)
b. Description: This report describes recommendations of standard care for individuals at risk for suicide, including a list of assessments for suicide screening and risk.
c. Link: https://tinyurl.com/kyzrxfys (i. (See Appendix A))

2. Name: National Patient Safety Goal for suicide prevention

a. Brief Source: R^3 Report| Requirement, Rational, Reference (2019)
b. Description: This report provides the rationale and references used to develop new requirements, including measures. This report focuses on the National Patient Safety Goal for individuals being treated for mental health conditions, including suicide.
c. Link: https://tinyurl.com/z4ppuskv - i. (see Rationale for Requirement NPSG 15.01.01,EP 2 (screen); Rationale for NPSG 15.01.01,EP 3 (assessment)).

3. Name: Suicide Screening and Assessment

a. Brief Source: Suicide Prevention Research Center (2014)
b. Description: This publication provides definitions on suicide screening vs. suicide assessment and links to resources that offer additional guidance on choosing and implementing screening and assessment programs.
c. Link: https://tinyurl.com/c6x6rpe7 i. (See Suicide Screening and Assessment: Selected Resources)

4. Name: A Review of Suicide Assessment Measures for Intervention Research with Adults and Older Adults

a. Brief Source: Gregory K. Brown, National Institute of Mental Health (2003)
b. Description: This review provides an investigation of the reliability and validity of suicide ideation and behavior measures for adults.
c. Link: https://tinyurl.com/b6ae4zab

5. Name: VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide

a. Brief Source: Department of Veterans Affairs and Department of Defense (2019)
b. Description: The Clinical Practice Guideline is based on a systematic review of clinical and epidemiological evidence related to suicide prevention. These guidelines were developed to define the relationships between different options for care and health outcomes, and includes the workgroup's ratings on the evidence used and how strongly they recommend each item reviewed.
c. Link: https://tinyurl.com/y9dup2w9 i. (See screening and evaluation)

6. Name: Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans

a. Brief Source: Nelson, Denneson, Low, Bauer, O'Neil, Kansagara, Teo (2017)
b. Description: This article reviewed studies to determine the accuracy and adverse effects of methods used to identify individuals at increased risk of suicide, as well as the effectiveness and adverse effects of suicide prevention interventions on reducing suicide attempts.
c. Link: https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600384


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