The Brief Suicide Cognitions Scale: Development and Clinical Application

Abstract

The study explored the development of the Brief Suicide Cognitions Scale (B-SCS), a simple and brief measure of suicide risk. The B-SCS provides a brief measure that captures critical aspects of suicide risk embedded in core beliefs about the self as unlovable, one's emotional experience as unbearable, and life problems as unsolvable (i.e., the suicidal belief system), resulting in chronic or enduring suicide risk and heightened vulnerability for acute episodes secondary to internal and external triggers. Data were analyzed from three diverse samples, including a student sample (N = 349), an inpatient psychiatric sample (N = 160), and a sample of emergency department (ED) patients presenting secondary to a suicidal crisis (N = 94). Those in the student and inpatient samples completed additional symptom measures (hopelessness, anxiety, depression) and the ED sample provided 6-month follow-up data for suicide attempts. Reliability (internal consistency, test-retest), concurrent validity, construct (divergent, convergent) validity, factorial, incremental, and predictive validity were evaluated, along with calculation of predictive value of negative and positive tests, sensitivity, and specificity estimates. The B-SCS demonstrated good reliability and validity, a unidimensional factor structure across samples, along with good predictive validity and value in real-world clinical settings. The B-SCS is a brief, reliable and valid measure of suicide risk, with good ability to identify those with enduring risk for subsequent suicide attempts. The B-SCS offers a unique contribution to understanding and assessing the nature of suicide risk over time targeting the suicidal belief system, with easy application across inpatient and outpatient clinical settings, and good predictive value.

Factors of suicidal behavior among inpatients with major depressive disorder: A retrospective case series

“…Suicide risk assessment screening tools are almost uniformly recommended to screen for depressed individuals with suicidal ideation in many countries; however, clinical practice has realistic time constraints, which often makes the predictive power of risk screening tools very limited. In addition to focusing on the risk factors for SB, which could be presented on the Suicide Risk Assessment Scale, Rudd et al (57) believe that there are four other identifiable aspects that can be addressed in the interview, including the temporal dynamics and natural variability of suicidal ideation and motivation to die, the importance of assessing constructs other than suicidal ideation that are convincingly related to enduring risk or chronic vulnerability to suicide (58)(59)(60), the importance of understanding and assessing the potential for poor individual adherence and cooperation with clinical care, and the elegant utility of the expressed wish of patients to live and wish to die, coupled with reasons for living and reasons for dying (57). Due to cultural differences, the form of the interview may vary between physicians in different countries or regions, but the above recommendations help clinicians screen for depressed patients with suicidal ideation in a simple and straightforward manner.…”

Defeat, Entrapment, and Hopelessness: Clarifying Interrelationships between Suicidogenic Constructs

“…Finally, the results suggest that individuals may not be able to conceptually distinguish between these constructs at the level of language; as Millner and colleagues [ 3 ] argue, “most clinical constructs have non-zero intercorrelations” (p. 3) as observed in the current study, and these verbal, language based constructs may do little to advance our knowledge of STB phenomenology, especially if populations in questions cannot or do not distinguish between or respond differentially to these constructs. Thus, more generalized concepts and phenomena such as the suicidal belief system become more and more appealing to theoretical and practical understanding as the field of suicidology advances in understanding [ 54 ].…”

Finding Effective and Efficient Ways to Integrate Research Advances Into the Clinical Suicide Risk Assessment Interview

“…Recent findings regarding the limited predictive value of traditional suicide risk assessment tools reinforces the need to assess other markers of enduring suicide risk that are strongly correlated with the emergence of suicidal behavior but are distinct from suicidal ideation and planning. For example, perceived burdensomeness (9), acquired capability (10), and identity-based hopelessness (21) have garnered considerable empirical evidence as useful indicators of heightened risk states. As with efforts to understand temporal dynamics, these constructs can be assessed with simple, straightforward questions.…”

“…The six-item Brief Suicide Cognitions Scale [B-SCS (21)], for instance, can be translated into clinical interview questions across three domains important to recognizing the presence of identity-based hopelessness: unlovability, unbearability, and unsolvability. Although the formal scale includes only six items, clinicians can translate findings to interview questions that assess each domain:…”