A psychometric study of the Suicide Cognitions Scale with psychiatric inpatients.

Abstract

The cognitive model of suicide makes specific predictions about the role of cognition in suicide risk. This study examined psychometric properties of the Suicide Cognitions Scale (SCS), an instrument designed to measure suicide-specific cognitions, in a sample of 150 patients (age range, 18-75 years, SD = 14.42; 56% female, 94% White) hospitalized for suicide risk associated with multiple, treatment-resistant psychiatric conditions. Findings revealed strong psychometric properties, including internal consistency and test-retest reliability. Incremental validity beyond depression and hopelessness was demonstrated in the prediction of suicidal ideation. Confirmatory factor analysis examining previously reported factor solutions suggested more consistency with a three-factor solution (Unlovability, Unbearability, and Unsolvability) relative to a two-factor solution. Good sensitivity to treatment response over the course of hospitalization also was demonstrated. The hypothesis of residual risk, derived from cognitive theory and predicting that lack of change in suicide schemas would be associated with higher suicide risk at discharge, was supported. Overall, these findings suggest considerable promise for the SCS as a measure of suicide risk that adds predictive utility to measures of depression and hopelessness, with potential usefulness in planning and monitoring treatment for suicidal individuals.

A Shortened Version of the Suicide Cognitions Scale for Identifying Chronic Pain Patients at Risk for Suicide

“…Items are scored on a 5‐point scale ranging from 1 (disagree strongly) to 5 (agree strongly). Previous research has supported a 2‐factor as well as a 3‐factor latent structure. The scale's reliability, concurrent validity, and predictive validity have been supported in outpatient as well as inpatient psychiatric samples …”

“…The SCS was developed to assess identity‐based suicide‐specific beliefs and schemas that reflect the chronic dimension of suicide risk that persists as a more stable construct underneath the more dynamic and transient aspects of suicide risk. Previous research with the SCS supports its utility as a concurrent and prospective predictor of suicidal thoughts and behaviors within psychiatric samples, but to date no studies have evaluated the scale's use in nonpsychiatric medical settings, and no studies have sought to reduce the full SCS from 18 items to a briefer version that can be implemented practically in busy clinical settings.…”

“…Confirmatory factor analysis (CFA) with robust weighted least‐squares estimation was used in the Mplus 6.12 software (Muthen & Muthen, 1998–2001) to examine the latent structure of the SCS. Three separate models were compared: a 1‐factor solution in which all items loaded onto a global factor; a 2‐factor solution identified by Bryan et al; and a 3‐factor solution identified by Ellis & Rufino . Good model fit was determined using the following criteria: nonsignificant chi‐square, root mean square error of approximation (RMSEA) < 0.05, comparative fit index (CFI) > 0.95, Tucker‐Lewis Index (TLI) > 0.95, and weighted root mean square residual (WRMR) < 1.00.…”

“…Consistent with the hypotheses of the fluid vulnerability theory, both SCS subscales differentiated between patients with a history of suicide attempts and those with a history of suicidal thoughts only, and predicted future suicide attempts better than current suicide ideation. Subsequent research among psychiatric inpatients suggests the SCS may actually have 3 latent factors as opposed to 2: Unlovability, Unbearability, and Unsolvability (ie, perceptions that one is hopelessly incapable of solving one's problems, and that suicide is the only solution). Each of the 3 factors was significantly better predictors of suicide ideation than depression and hopelessness, with the Unsolvability and Unlovability factors being the relative best predictors.…”

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample

“…Internal consistency was good (α = .86). The SCS was entered as a covariate given the relationship between suicide-specific hopelessness and suicide attempt history (Ellis & Rufino, 2015). …”